title: Analysis of remote trauma transfers in South Central Texas with comparison with current US combat operations: results of the RemTORN-I study.
abstract: BACKGROUND
  This study aimed to analyze demographic, epidemiologic, temporal, and outcome data from an integrated trauma registry of patients undergoing initial stabilization and transfer within a mature domestic trauma network; compare data with a companion subset from the Department of Defense Trauma Registry. Texas Trauma Service Area-P is composed of 25 counties, 15 rural Level IV trauma centers (no acute care surgery), and two Level I trauma centers.
  
  
  METHODS
  This study has a retrospective cohort design. We hypothesize that Injury Severity Scores (ISSs), time intervals, and other clinical indicators would be complimentary to contemporary combat casualties. Inclusion criteria include age 18 years to 80 years, transferred from Level IV to Level I trauma center, or expired en route.
  
  
  RESULTS
  A total of 543 subjects (84%) met the criteria and were analyzed. Averages and confidence intervals were as follows: age of 40 years (38-41 years), males at 81%, ISS of 10 (10-11), intensive care unit stay of 2 days (1-3 days), and hospital stay of 5 days (4-6 days). Mechanisms of injury were as follows: penetrating (15%), blunt weapon (19%), stabs (9%), burns (5%), and gunshots (5%). Eight percent received blood within the first 24 hours. Survival was at 98%. Time intervals (95% confidence interval) were as follows: prehospital at 1:43 (1:29-1:58), Level IV dwell time at 3:17 (3:06-3:28), interfacility transfer at 1:43 (1:36-1:49), and total at 6:39 (6:20-6:58). RemTORN cases were older, spent longer time en route to Level I, and had ISS similar to combat casualties. Rates of blood transfusion in the first 24 hours and survival were similar in order of magnitude.
  
  
  CONCLUSIONS
  The RemTORN platform is operational. Demographic, epidemiologic, and temporal characteristics as observed will support clinical investigations of traumatic coagulopathy, shock, and potential interventions before Level I arrival. Results of such investigations will likely be applicable to the contemporary and future battlefield.
authors.affiliation: US Army Medical Department Center and School, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas 78234-6315, USA. robert.gerhardt@us.army.mil
authors.forename: Robert T
authors.initials: RT
authors.lastname: Gerhardt
authors.forename: Alexandra R
authors.initials: AR
authors.lastname: Koller
authors.forename: Todd E
authors.initials: TE
authors.lastname: Rasmussen
authors.forename: Brandi
authors.initials: B
authors.lastname: Wright
authors.forename: Eleanor
authors.initials: E
authors.lastname: Lacson
authors.forename: Preston
authors.initials: P
authors.lastname: Love
authors.forename: Shawn
authors.initials: S
authors.lastname: Salter
authors.forename: Ronald
authors.initials: R
authors.lastname: Stewart
authors.forename: Brian
authors.initials: B
authors.lastname: Eastridge
authors.forename: Eric
authors.initials: E
authors.lastname: Epley
authors.forename: Lorne
authors.initials: L
authors.lastname: Blackbourne
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D008887:Military Medicine / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D019035:Rural Health Services / Q000706:statistics & numerical data; D013781:Texas / Q000453:epidemiology; D014187:Transportation of Patients / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000706:statistics & numerical data; D014481:United States; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D055815:Young Adult