Utilizing a trauma systems approach to benchmark and improve combat casualty care.
BACKGROUND
Derived from the necessity to improve the outcomes of soldiers injured on the battlefield, the U.S. military forces developed and implemented the Joint Theater Trauma System (JTTS) and the Joint Theater Trauma Registry based on U.S. civilian trauma system models. The purpose of this analysis was to develop battlefield injury outcome benchmark metrics and to evaluate the impact of JTTS-driven performance improvement interventions.


METHODS
To quantify these achievements, the Joint Theater Trauma Registry captured mechanistic, physiologic, diagnostic, therapeutic, and outcome data on 18,377 injured patients from January 2004 to May 2008 for analysis. Benchmarks were developed and statistically validated by using control chart methodology.


RESULTS
The majority (66.4%) of battlefield wounds were penetrating mechanism, 23.3% of all patients had an Injury Severity Score of > or = 16, 21.8% had a base deficit of > or = 5, 30.5% of patients required blood, and 6.8% required massive transfusion (> or = 10 units red blood cell per 24 hours). In this severely injured population from the battlefield, the JTTS developed several pertinent benchmark metrics to assess quality of care associated with postinjury complications and mortality. The implementation of 27 JTTS-developed evidenced-based clinical practice guidelines and an improved information dissemination process was associated with a decrease in aggregate postinjury complications by 54%.


CONCLUSIONS
Despite the numerous challenges of a global trauma system, the JTTS has set the standard for trauma care on the modern battlefield utilizing evidence-based medicine. The development of injury care benchmarks enhanced the evolution of the combat casualty care performance improvement process within the trauma system.
Eastridge
Brian J
BJ
U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas 78234-6315, USA. brian.eastridge@amedd.army.mil
Wade
Charles E
CE
Spott
Mary A
MA
Costanzo
George
G
Dunne
James
J
Flaherty
Stephen
S
Holcomb
John B
JB
West
Susan
S
Apodaca
Amy
A
Blackbourne
Lorne
L
Casscells
S Ward
SW
D019985:Benchmarking / Q000458:organization & administration*; D006801:Humans; D008887:Military Medicine / Q000458:organization & administration*; D008889:Military Personnel; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014218:Triage / Q000458:organization & administration; D014481:United States; D014857:Warfare; D014947:Wounds and Injuries / Q000628:therapy*