Page 20 - JSOM Summer 2024

Methods Results
Data Acquisition Our initial data set included 25,897 casualties, of whom 2,178
This is a secondary analysis of previously published data from (8.4%) had a tube thoracostomy placed within 24 hours of ad-
the Department of Defense Trauma Registry (DoDTR), which mission (Table 1). The mean age was 25 (range 21–30) years,
we have previously described. The original data set included with the vast majority being male 97% (2,117). The U.S. mili-
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all casualties within the DoDTR that had any prehospital in- tary represented only 26% (562) of those who received a tube
tervention or assessment documented from 2007 to 2020. The thoracostomy, whereas partner forces and humanitarian ca-
U.S. Army Institute of Surgical Research (USAISR) regulatory sualties represented 33% (710) and 37% (797), respectively.
office reviewed protocol H-20-015nh and determined it was Explosives and firearm mechanisms of injury were similar at
exempt from Institutional Review Board oversight. We ob- 47% (1,027) and 43% (936), respectively. The composite ISS
tained only de-identified data. was 20 (IQR 13–39), with AIS ≥3 by body region (binary) pro-
portions for thorax 62% (1,351), with extremities 29% (629),
Study Population abdomen 22% (473), and head/neck 22% (473). Most (87%)
We included all casualties in the DoDTR who underwent tube survived to hospital discharge.
thoracostomy placement. Our inclusion criteria required that
casualties underwent tube thoracostomy placement within 24 TABLE 1 Tube Thoracostomy Casualty Data (n=2,178)
hours of admission to a military treatment facility (Role 3). We Demographics No. (%)*
assumed accurate documentation of all care rendered. Age, y, mean (range) 25 (21–30)
Male 2,117 (97)
Measurements Outcome, alive 1,889 (87)
We collected all data from the DoDTR. This registry, formerly
known as the Joint Theater Trauma Registry, is the data repos- Affiliation
itory for DoD trauma-related injuries. 9,10 The DoDTR includes U.S. military 562 (26)
documentation regarding demographics, injury-producing in- Coalition 109 (5)
cidents, diagnoses, treatments, and outcomes of injuries sus- Partner force 710 (33)
tained by U.S./non-U.S. military and U.S./non-U.S. civilian Humanitarian 797 (37)
personnel in wartime and peacetime (including humanitar- Mechanism of injury
ian casualties) from the point of injury to final disposition. Explosive 1,027 (47)
Short-term outcome data are available for non-U.S. casual- Firearm 936 (43)
ties. The DoDTR comprises all patients admitted to a Role 3
(fixed-facility) or forward resuscitative surgical detachment MVC 127 (6)
(legacy forward surgical team) or a Role 2 with surgical team Other 88 (4)
augmentation with an injury diagnosis using the International Composite ISS, median (IQR) 20 (13–39)
Classification of Disease 9th Edition (ICD-9) between 800– AIS by body region, no. (range)
959.9, near-drowning/drowning with associated injury (ICD-9 Head/neck 0 (0–2)
994.1) or inhalational injury (ICD-9 987.9) and trauma occur- Facial 0 (0–1)
ring within 72 hours of presentation. Data are collected from Thorax 3 (2–3)
standard deployed data collection forms and entered into the Abdomen 0 (0–2)
registry by trained registrars. Extremities 2 (0–3)
Skin 1 (0–1)
Variables and Outcomes
We described the survival of all casualties. Additional vari- Serious injury by body region
ables evaluated included casualty demographics and injury Head/neck 473 (22)
severity based on the abbreviated injury scale (AIS) score by Facial 15 (1)
body region and the composite injury severity score (ISS). Thorax 1,351 (62)
Owing to the extreme skewing of the AIS data, we have also Abdomen 473 (22)
presented the AIS data as binary serious (AIS ≥3) versus not Extremities 629 (29)
serious (AIS <3) as we have done with previous analyses. 7,11 Skin 116 (5)
We obtained registry data related to prehospital interventions. *Unless otherwise specified.
We assessed types and quantities of fluids administered to AIS = abbreviated injury scale; ISS = injury severity score; MVC =
these casualties over their first 24 hours of admission, which motor vehicle collision; IQR = interquartile range.
may offer insight into blood transfusion requirements due to For prehospital interventions (Table 2), 13% of patients (276)
hemothoraces. underwent needle decompression, 3% (73) received a chest
seal, and 6% (130) underwent tube thoracostomy placement.
Analysis Non-thoracic interventions included limb tourniquet for 19%
We performed all statistical analysis using Microsoft Excel of patients (416), intraosseous access (IO) for 10% (228), intu-
(version 365, Redmond, WA) and JMP Statistical Discovery bation for 9% (208), blood transfusion for 5% (115), and crys-
from SAS (version 17, Cary, NC). We present descriptive sta- talloid transfusion for 3% (67). Medications administered were
tistics to characterize the study population. We present con- ketamine for 11% (241), fentanyl for 19% (412), and morphine
tinuous variables as means with 95% CIs, non-parametric for 16% (347). Only 10% of casualties received antibiotics.
continuous variables and ordinal variables as medians with
interquartile ranges (IQRs), and nominal variables as percent- The mean systolic blood pressure was 112mmHg (95% CI
ages and numbers. 111–113) and the mean diastolic blood pressure was 64mmHg

18 | JSOM Volume 24, Edition 2 / Summer 2024