Analysis of Remote Trauma Transfers in South Central Texas with Comparison with Current US Combat Operations: Results of the RemTORN-I Study
BROOKE ARMY MEDICAL CENTER FORT SAM HOUSTON TX
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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, bluntweapon 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 143 129-158, Level IV dwell time at 317 306-328, interfacility transfer at 143 136-149, and total at 639 620-658. 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. CONCLUSION 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.
- Medicine and Medical Research