title: Preflight Variables Are Associated With Increased Ventilator Days and 30-Day Mortality in Trauma Casualties Evacuated by Critical Care Air Transport Teams: An Exploratory Retrospective Study.
abstract: There are no tools to predict outcomes in the U.S. Air Force Critical Care Air Transport Team (CCATT) trauma patients. The objective of this study was to identify associations between preflight variables and outcomes that could assist planning of ongoing critical care.
  
  
  
  This Institutional Review Board approved retrospective study included all patients evacuated from Afghanistan by CCATT between 2007 and 2011. Preflight variables were assessed for associations and examined in logistic regression models. Ventilator time over 72 hours, and 30-day mortality were the primary and secondary outcomes respectively.
  
  
  
  1,308 trauma patients (24 years, 98% male) were included; 72% blast. Injury severity score (odds ratio [OR] = 1.04 [1.03-1.06]), preflight packed red blood cell units transfused (OR = 1.05 [1.04-1.07]), and preflight intubated status (OR = 11.9 [8.53-16.89]) were independently associated with increased ventilator days; a composite produced an area under the curve of 0.85 with 86% sensitivity and 56% specificity. Injury severity score (OR = 1.06 [1.03-1.09]), prothrombin time (OR = 2.13 [1.18-4.47]), preflight intubated status (OR = 9.2 [1.88-166.11]), and whole blood (OR = 3.18 [1.38-7.04]) were associated with 30-day mortality; a composite produced an area under the curve of 0.84 with 71% sensitivity and 57% specificity.
  
  
  
  In our large CCATT study a number of preflight variables were associated with outcomes, which may assist in the future planning of critical care services.
authors.affiliation: Air Force En route Care Research Center, U.S. Army Institute of Surgical Research/59th Medical Wing, 3698 Chambers Pass Road, Building 3611, Fort Sam Houston, San Antonio, TX 78234.
authors.forename: Ed
authors.initials: E
authors.lastname: Barnard
authors.affiliation: Air Force En route Care Research Center, U.S. Army Institute of Surgical Research/59th Medical Wing, 3698 Chambers Pass Road, Building 3611, Fort Sam Houston, San Antonio, TX 78234.
authors.forename: Alejandra G
authors.initials: AG
authors.lastname: Mora
authors.affiliation: Air Force En route Care Research Center, U.S. Army Institute of Surgical Research/59th Medical Wing, 3698 Chambers Pass Road, Building 3611, Fort Sam Houston, San Antonio, TX 78234.
authors.forename: Vikhyat S
authors.initials: VS
authors.lastname: Bebarta
mesh_terms: D000328:Adult; D000337:Aerospace Medicine; D055826:Afghan Campaign 2001-; D000346:Afghanistan; D017732:Air Ambulances / Q000592:standards / Q000706:statistics & numerical data; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008889:Military Personnel; D008991:Monitoring, Physiologic / Q000706:statistics & numerical data; D009026:Mortality; D012042:Registries / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000379:methods* / Q000592:standards; D012189:Retrospective Studies; D014195:Travel / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy*