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Evaluation of military trauma system practices related to complications after injury

Palm, Keith RN; Apodaca, Amy PhD; Spencer, Debra RN; Costanzo, George MD; Bailey, Jeffrey MD; Fortuna, Gerald 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 S465–S471
doi: 10.1097/TA.0b013e31827548a9

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 injury and complication after injury surveillance information diffusion through the JTTS, via the dissemination of clinical practice guidelines and process improvements, would be associated with improved combat casualty clinical outcomes.

METHODS The current analysis was designed to profile different aspects of trauma system performance improvement, including monitoring of frequent posttraumatic complications, the assessment of an emerging complication trend, and measurement of the impact of the system interventions to identify potential practices for future performance improvement. Data captured from the Joint Theater Trauma Registry on patients admitted to military medical treatment facilities as a result of wounds incurred in Iraq and Afghanistan from 2003 to 2010 were retrospectively analyzed to determine the potential impact of complication surveillance and process improvement initiatives on clinical practice.

RESULTS Developed metrics demonstrated that the surveillance capacity and evidence-based quality improvement initiatives disseminated through the JTTS were associated with improved identification and mitigation of complications following battlefield injury.

CONCLUSION The Joint Trauma System enables evidence-based practice across the continuum of military trauma care. Concurrent data collection and performance improvement activities at the local and system level facilitate timely clinical intervention on identified trauma complications and the subsequent measurement of the effectiveness of those interventions.

LEVEL OF EVIDENCE Epidemiologic study, level III.

From the US Army Institute of Surgical Research (K.L., A.A., D.S., G.C., J.B., L.H.B., M.A.S., B.J.E.), Fort Sam Houston, Texas; Landstuhl Regional Medical Center (G.F.), Landstuhl, Germany.

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.