Infections Complicating the Care of Combat Casualties During Operations Iraqi Freedom and Enduring Freedom
Infections Complicating the Care of Combat Casualties During Operations Iraqi Freedom and Enduring Freedom
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DOI：
10.1097/ta.0b013e3182218c99
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发表时间：
2011-07-01
影响因子：
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通讯作者：
Hospenthal, Duane R.
中科院分区：
文献类型：
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作者：
Murray, Clinton K.;Wilkins, Kenneth;Hospenthal, Duane R.
工作背景：继续评估伤员并发症，如感染，有助于制定循证指南，以减少过高的发病率和死亡率。我们研究了联合战区创伤登记处（JTTR）的感染和潜在的危险因素，如输血，在伊拉克和阿富汗创伤患者。方法：2003年3月19日至2009年4月13日期间完成记录的部署相关伤害JTTR条目，使用国际疾病分类-根据解剖/临床综合征和/或感染生物体类型定义的9种感染代码进行评价。风险因素包括损伤机制、患者人口统计学资料、损伤严重度评分（ISS）和输血，包括大量输血（>= 10单位的浓缩红细胞）。结果：我们回顾了16，742例患者条目（15，021例来自伊拉克自由行动（9，883例战斗受伤[BI]）和1，721例来自持久自由行动（1，090 BI）。其中96.6%为男性，77.6%为陆军人员。大多数BI是由于爆炸装置（36.3%）。有921例患者（5.5%）有一个或多个感染代码，仅111例（0.6%）记录死亡（16例感染）。感染通常为革兰氏阴性菌（47.6%），涉及皮肤/伤口感染（26.7%）和肺部感染（14.6%）。单变量和多变量分析中最显着的风险因素或协会是日历年的创伤，ISS，和模式injure.Conclusion：5.5%的感染率是一致的，与以前的军事和民用创伤文献，但是，与JTTR的局限性，感染率可能是一个代表性不足，由于V级和长期感染并发症的数据。战斗创伤主要与革兰氏阴性菌有关，通常涉及伤口或其他皮肤结构的感染和肺部感染，如肺炎。它们通常与较高的ISS和头部，颈部和面部受伤有关。
Background: Continued assessment of casualty complications, such as infections, enables the development of evidence-based guidelines to mitigate excess morbidity and mortality. We examine the Joint Theater Trauma Registry (JTTR) for infections and potential risk factors, such as transfusions, among Iraq and Afghanistan trauma patients.Methods: JTTR entries from deployment-related injuries with completed records between March 19, 2003, and April 13, 2009, were evaluated using International Classification of Diseases-9 codes for infections defined by anatomic/clinical syndromes and/or type of infecting organisms. Risk factors included mechanisms of injury, patient demographics, Injury Severity Score (ISS), and transfusion, including massive transfusions (>= 10 units of packed red blood cells).Results: We reviewed 16,742 patients entries (15,021 from Operation Iraqi Freedom (9,883 battle injuries [BI]) and 1,721 from Operation Enduring Freedom (1,090 BI). A total of 96.6% were men and 77.6% were Army personnel. The majority of BI were due to explosive devices (36.3%). There were 921 patients (5.5%) who had one or more infection codes with only 111 (0.6%) recorded deaths (16 with infections). Infections were commonly gram-negative bacteria (47.6%) involving skin/wound infections (26.7%), and lung infections (14.6%). Risk factors or associations that were most notable in univariate and multivariate analysis were calendar year of trauma, ISS, and pattern of injury.Conclusion: The 5.5% infection rate is consistent with previous military and civilian trauma literature; however, with the limitations of the JTTR, the infection rate is likely an underrepresentation due to inadequate level V and long-term infectious complications data. Combat operational trauma is primarily associated with gram-negative bacteria typically involving infections of wounds or other skin structures and lung infections such as pneumonia. They are commonly linked with higher ISS and injuries to the head, neck, and face.