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Evaluation of military trauma system practices related to damage-control resuscitation

Palm, Keith RN; Apodaca, Amy PhD; Spencer, Debra RN; Costanzo, George MD; Bailey, Jeffrey MD; Blackbourne, Lorne H. MD; Spott, Mary Ann; Eastridge, Brian J. MD

Journal of Trauma and Acute Care Surgery: December 2012 - Volume 73 - Issue 6 - p S459–S464
doi: 10.1097/TA.0b013e3182754887
Original Articles

BACKGROUND The Joint Theater Trauma System (JTTS) was developed with the vision that every soldier, marine, sailor, and airman injured on the battlefield would have the optimal chance for survival and maximum potential for functional recovery. In this analysis, we hypothesized that information diffusion through the JTTS, via the dissemination of clinical practice guidelines and process improvements, would be associated with the acceptance of evidence-based practices and decreases in trauma practice variability.

METHODS The current evaluation was designed as a single time-series quasi-experimental study as a preanalysis and postanalysis relative to the implementation of clinical practice guidelines and process improvement interventions. Data captured from patients admitted to hospital-level (Level III) military treatment facilities in Iraq and Afghanistan from 2003 to 2010 were retrospectively analyzed from the Joint Theater Trauma Registry (JTTR) to determine the potential impact of process improvement initiatives on clinical practice.

RESULTS The JTTS clinical practice guidelines for massive transfusion led to increased compliance with balanced component transfusion and decreased practice variability. During the course of the evaluation period, hypothermia on presentation decreased dramatically after the publication of the hypothermia prevention and management clinical practice guideline.

CONCLUSION Developed metrics demonstrate that evidence-based quality improvement initiatives disseminated through the JTTS were associated with improved clinical practice of resuscitation following battlefield injury.

LEVEL OF EVIDENCE Therapeutic/care management study, level IV.

From the US Army Institute of Surgical Research, Fort Sam Houston, Texas.

The opinions or assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the US Department of the Army or the US Department of Defense.

Address for reprints: Brian J. Eastridge, MD, Professor of Surgery, Trauma Medical Director, Trauma and Emergency Surgery University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive (MC 7740), San Antonio, TX 78229; email:

© 2012 Lippincott Williams & Wilkins, Inc.