title: Evaluation of military trauma system practices related to complications after injury.
abstract: BACKGROUND
  The Joint Theater Trauma System (JTTS) was developed with the vision that every soldier, marine, sailor, and airman injured on the battlefield would have the optimal chance for survival and maximum potential for functional recovery. In this analysis, we hypothesized that injury and complication after injury surveillance information diffusion through the JTTS, via the dissemination of clinical practice guidelines and process improvements, would be associated with improved combat casualty clinical outcomes.
  
  
  METHODS
  The current analysis was designed to profile different aspects of trauma system performance improvement, including monitoring of frequent posttraumatic complications, the assessment of an emerging complication trend, and measurement of the impact of the system interventions to identify potential practices for future performance improvement. Data captured from the Joint Theater Trauma Registry on patients admitted to military medical treatment facilities as a result of wounds incurred in Iraq and Afghanistan from 2003 to 2010 were retrospectively analyzed to determine the potential impact of complication surveillance and process improvement initiatives on clinical practice.
  
  
  RESULTS
  Developed metrics demonstrated that the surveillance capacity and evidence-based quality improvement initiatives disseminated through the JTTS were associated with improved identification and mitigation of complications following battlefield injury.
  
  
  CONCLUSIONS
  The Joint Trauma System enables evidence-based practice across the continuum of military trauma care. Concurrent data collection and performance improvement activities at the local and system level facilitate timely clinical intervention on identified trauma complications and the subsequent measurement of the effectiveness of those interventions.
  
  
  METHODS
  Epidemiologic study, level III.
authors.affiliation: US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Palm
authors.forename: Amy
authors.initials: A
authors.lastname: Apodaca
authors.forename: Debra
authors.initials: D
authors.lastname: Spencer
authors.forename: George
authors.initials: G
authors.lastname: Costanzo
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Bailey
authors.forename: Gerald
authors.initials: G
authors.lastname: Fortuna
authors.forename: Lorne H
authors.initials: LH
authors.lastname: Blackbourne
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Spott
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Eastridge
mesh_terms: D055826:Afghan Campaign 2001-; D001134:Arm Injuries / Q000175:diagnosis / Q000601:surgery*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003161:Compartment Syndromes / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D054542:Iraq War, 2003-2011; D007869:Leg Injuries / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008887:Military Medicine / Q000592:standards* / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D058996:Quality Improvement; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States; D014857:Warfare