BETHESDA, MD — In planning and preparing for the future possibility of large-scale combat operations, military medicine might have to decide which wounded warriors can have delayed evacuations. One issue is the need for blood products.
“The U.S. military is transitioning into a posture preparing for large-scale combat operations in which delays in evacuation may become common,” according to a new study in The Medicine Journal from the U.S. Army Office of the Surgeon General. “It remains unclear which casualty population can have their initial surgical interventions delayed, thus reducing the evacuation demands.”1
Researchers from the Uniformed Services University of the Health Sciences in Bethesda, MD, and Brooke Army Medical Center at JBSA Fort Sam Houston, TX, and colleagues performed a secondary analysis of a previously described dataset from the DoD Trauma Registry (DODTR) focused on casualties who received prehospital care.
The goal was to determine (1) of those who underwent operative intervention, the proportion of surgeries occurring three or more days post-injury, and (2) of those who underwent early versus delayed surgery, the proportions who required blood products.
The focus was on 6,558 U.S. military casualties who underwent surgical intervention–6,224 of those early (less than three days from injury) and 333 delayed (more than three days from injury).
Results indicated that the median Injury Severity Score (ISS) was higher in the early cohort (10 versus 6, p is less than 0.001). In the early cohort, the researchers determined that the most common were serious injuries to the:
- head (12% versus 5%, p is less than 0.001),
- thorax (13% versus 9%, p=0.041),
- abdomen (10% versus 5%, p=0.001),
- extremities (37% versus 14%, p is less than 0.001), and
- skin (4% versus less than 1%, p=0.001).
“Survival to discharge was lower in the early cohort (97% versus 100%, p is less than 0.001),” they advised.
The study also pointed out that mean whole blood consumption was higher in the early cohort (0.5 versus 0 units, p is less than 0.001), as was packed red blood cells (6.3 versus 0.5, p is less than 0.001), platelets (0.9 versus 0, p is less than 0.001), and fresh frozen plasma (4.5 versus 0.2, p is less than 0.001).
“The administration of any units of packed red blood cells and whole blood was higher for the early cohort (37% versus 7%, p is less than 0.001), as was a ≥3 units threshold (30% versus 3%, p is less than 0.001), and ≥10 units threshold (18% versus 1%, p is less than 0.001),” according to the report.
The authors concluded that few combat casualties underwent delayed surgical interventions defined as ≥3 days post injury, and only a small number of casualties with delayed surgical intervention received blood products, adding, “Casualties who received early surgical intervention were more likely to have higher injury severity scores, and more likely to receive blood.”
- Arnold JL, MacDonald AG, Baker JB, Rizzo JA, April MD, Schauer SG. An Assessment of Casualties Undergoing Delayed Surgical Intervention in the Combat Setting. Med J (Ft Sam Houst Tex). 2023 Jan-Mar;(Per 23-1/2/3):28-33. PMID: 36607295.
