Four Anchor Repair of Jersey Finger.

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Abstract

[Indexed for MEDLINE] 20. J Trauma Acute Care Surg. 2024 Aug 1;97(2S Suppl 1):S82-S90. doi: 10.1097/TA.0000000000004414. Epub 2024 Jul 12. A trauma expert consensus: Capabilities are required early to improve survivability from traumatic injury. Gurney JM(1), Kotwal RS, Holcomb JB, Staudt AM, Eastridge B, Sirkin M, Jensen S, Shackelford S, Sonka BJ, Wilson J, Montgomery H, Gross K, Warren W, Mazuchowski E, Rohrer AJ. Author information: (1)From the Joint Trauma System (J.M.G., R.S.K., S.J., B.J.S., J.W., H.M., A.J.R.), Defense Health Agency, Joint Base San Antonio-Fort Sam Houston, Texas; Department of Surgery (J.M.G., S.S., S.J., E.M.), Department of Military and Emergency Medicine (R.S.K., E.M.), and Department of Pathology (A.J.R., E.M.), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Trauma and Acute Care Surgery (J.B.H.), University of Alabama at Birmingham, Birmingham, Alabama; The Geneva Foundation (A.M.S.), US Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston; Department of Surgery, Trauma and Acute Care Surgery (B.E.), University of Texas Health San Antonio, San Antonio, Texas; Joint Medical Unit (M.S.), Joint Special Operations Command, United States Special Operations Command, Fort Liberty, North Carolina; San Antonio Uniformed Services Health Education Consortium (M.S.), Joint Base San Antonio-Fort Sam Houston, Texas; Defense Health Agency (S.J., S.S.), Colorado Trauma Medical Director, Colorado Springs, Colorado; Department of Trauma and Acute Care Surgery (K.G.), Cooper University Medical Center, Camden, New Jersey; HNL Lab Medicine (E.M.), Allentown, Pennsylvania; and Armed Forces Medical Examiner System (W.W., A.J.R.), Defense Health Agency, Dover Air Force Base, Delaware. BACKGROUND: Mortality reviews examine US military fatalities resulting from traumatic injuries during combat operations. These reviews are essential to the evolution of the military trauma system to improve individual, unit, and system-level trauma care delivery and inform trauma system protocols and guidelines. This study identifies specific prehospital and hospital interventions with the potential to provide survival benefits. METHODS: US Special Operations Command fatalities with battle injuries deemed potentially survivable (2001-2021) were extracted from previous mortality reviews. A military trauma review panel consisting of trauma surgeons, forensic pathologists, and prehospital and emergency medicine specialists conducted a methodical review to identify prehospital, hospital, and resuscitation interventions (e.g., laparotomy, blood transfusion) with the potential to have provided a survival benefit. RESULTS: Of 388 US Special Operations Command battle-injured fatalities, 100 were deemed potentially survivable. Of these (median age, 29 years; all male), 76.0% were injured in Afghanistan, and 75% died prehospital. Gunshot wounds were in 62.0%, followed by blast injury (37%), and blunt force injury (1.0%). Most had a Maximum Abbreviated Injury Scale severity classified as 4 (severe) (55.0%) and 5 (critical) (41.0%). The panel recommended 433 interventions (prehospital, 188; hospital, 315). The most recommended prehospital intervention was blood transfusion (95%), followed by finger/tube thoracostomy (47%). The most common hospital recommendations were thoracotomy and definitive vascular repair. Whole blood transfusion was assessed for each fatality: 74% would have required ≥10 U of blood, 20% would have required 5 to 10 U, 1% would have required 1 to 4 U, and 5% would not have required blood products to impact survival. Five may have benefited from a prehospital laparotomy. CONCLUSION: This study systematically identified capabilities needed to provide a survival benefit and examined interventions needed to inform trauma system efforts along the continuum of care. The determination was that blood transfusion and massive transfusion shortly after traumatic injury would impact survival the most. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level V. Copyright © 2024 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government. DOI: 10.1097/TA.0000000000004414