Joint Theater Trauma System Implementation of Burn Resuscitation Guidelines Improves Outcomes in Severely Burned Military Casualties
BACKGROUND:Between March 2003 and June 2007, our burn center received 594 casualties from the conflicts in Iraq and Afghanistan. Ongoing acute burn resuscitation as severely burned casualties are evacuated over continents is very challenging. To help standardize care, burn resuscitation guidelines (...
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| Veröffentlicht in: | The journal of trauma 2008-02, Vol.64 (2 Suppl), p.S146-S152 |
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| creator | Ennis, Jody L. Chung, Kevin K. Renz, Evan M. Barillo, David J. Albrecht, Michael C. Jones, John A. Blackbourne, Lorne H. Cancio, Leopoldo C. Eastridge, Brian J. Flaherty, Steven F. Dorlac, Warren C. Kelleher, K S. Wade, Charles E. Wolf, Steven E. Jenkins, Donald H. Holcomb, John B. |
| description | BACKGROUND:Between March 2003 and June 2007, our burn center received 594 casualties from the conflicts in Iraq and Afghanistan. Ongoing acute burn resuscitation as severely burned casualties are evacuated over continents is very challenging. To help standardize care, burn resuscitation guidelines (BRG) were devised along with a burn flow sheet (BFS) and disseminated via the new operational Joint Theater Trauma System to assist deployed providers.
METHODS:After the BRG was implemented in January 2006, BRF data were prospectively collected in consecutive military casualties with >30% total body surface area (TBSA) burns (BRG Group). Baseline demographic data and fluid requirements for the first 24 hours of the burn resuscitation were collected from the BFS. Percentage full thickness TBSA burns, presence of inhalation injury, injury severity score, resuscitation-related abdominal compartment syndrome, and mortality were collected from our database. Individual charts were reviewed to determine the presence of extremity fasciotomies and myonecrosis. These results were compared with consecutive military casualties admitted during the 2-year- period before the system-wide implementation of the BRG (control group).
RESULTS:One hundred eighteen military casualties with burns >30% TBSA were admitted between January 2003 and June 2007, with n = 56 in the BRG group and n = 62 in the control group. The groups were different in age, but similar in %TBSA, %full thickness, presence of inhalation injury, and injury severity score. There was no difference in the rate of extremity fasciotomies or the incidence of myonecrosis between groups.
CONCLUSIONS:The composite endpoint of abdominal compartment syndrome and mortality was significantly lower in the BRG group compared with the control group (p = 0.03). Implementation of the BRG and system-wide standardization of burn resuscitation improved outcomes in severely burned patients. Utilization of the joint theater trauma system to implement system-wide guidelines is effective and can help improve outcomes. |
| doi_str_mv | 10.1097/TA.0b013e318160b44c |
| format | Article |
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METHODS:After the BRG was implemented in January 2006, BRF data were prospectively collected in consecutive military casualties with >30% total body surface area (TBSA) burns (BRG Group). Baseline demographic data and fluid requirements for the first 24 hours of the burn resuscitation were collected from the BFS. Percentage full thickness TBSA burns, presence of inhalation injury, injury severity score, resuscitation-related abdominal compartment syndrome, and mortality were collected from our database. Individual charts were reviewed to determine the presence of extremity fasciotomies and myonecrosis. These results were compared with consecutive military casualties admitted during the 2-year- period before the system-wide implementation of the BRG (control group).
RESULTS:One hundred eighteen military casualties with burns >30% TBSA were admitted between January 2003 and June 2007, with n = 56 in the BRG group and n = 62 in the control group. The groups were different in age, but similar in %TBSA, %full thickness, presence of inhalation injury, and injury severity score. There was no difference in the rate of extremity fasciotomies or the incidence of myonecrosis between groups.
CONCLUSIONS:The composite endpoint of abdominal compartment syndrome and mortality was significantly lower in the BRG group compared with the control group (p = 0.03). Implementation of the BRG and system-wide standardization of burn resuscitation improved outcomes in severely burned patients. Utilization of the joint theater trauma system to implement system-wide guidelines is effective and can help improve outcomes.</description><identifier>ISSN: 0022-5282</identifier><identifier>EISSN: 1529-8809</identifier><identifier>DOI: 10.1097/TA.0b013e318160b44c</identifier><identifier>PMID: 18376158</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins, Inc</publisher><subject>Adult ; Burn Units ; Burns - etiology ; Burns - mortality ; Burns - therapy ; Cohort Studies ; Emergency Treatment - standards ; Guideline Adherence ; Humans ; Iraq War, 2003-2011 ; Military Personnel ; Practice Guidelines as Topic ; Retrospective Studies ; Treatment Outcome ; United States</subject><ispartof>The journal of trauma, 2008-02, Vol.64 (2 Suppl), p.S146-S152</ispartof><rights>2008 Lippincott Williams & Wilkins, Inc.</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3482-c76e663e98cccca422562e8fe9e723ea009d07c5cae4363c2af762af10b21d673</citedby><cites>FETCH-LOGICAL-c3482-c76e663e98cccca422562e8fe9e723ea009d07c5cae4363c2af762af10b21d673</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18376158$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ennis, Jody L.</creatorcontrib><creatorcontrib>Chung, Kevin K.</creatorcontrib><creatorcontrib>Renz, Evan M.</creatorcontrib><creatorcontrib>Barillo, David J.</creatorcontrib><creatorcontrib>Albrecht, Michael C.</creatorcontrib><creatorcontrib>Jones, John A.</creatorcontrib><creatorcontrib>Blackbourne, Lorne H.</creatorcontrib><creatorcontrib>Cancio, Leopoldo C.</creatorcontrib><creatorcontrib>Eastridge, Brian J.</creatorcontrib><creatorcontrib>Flaherty, Steven F.</creatorcontrib><creatorcontrib>Dorlac, Warren C.</creatorcontrib><creatorcontrib>Kelleher, K S.</creatorcontrib><creatorcontrib>Wade, Charles E.</creatorcontrib><creatorcontrib>Wolf, Steven E.</creatorcontrib><creatorcontrib>Jenkins, Donald H.</creatorcontrib><creatorcontrib>Holcomb, John B.</creatorcontrib><title>Joint Theater Trauma System Implementation of Burn Resuscitation Guidelines Improves Outcomes in Severely Burned Military Casualties</title><title>The journal of trauma</title><addtitle>J Trauma</addtitle><description>BACKGROUND:Between March 2003 and June 2007, our burn center received 594 casualties from the conflicts in Iraq and Afghanistan. Ongoing acute burn resuscitation as severely burned casualties are evacuated over continents is very challenging. To help standardize care, burn resuscitation guidelines (BRG) were devised along with a burn flow sheet (BFS) and disseminated via the new operational Joint Theater Trauma System to assist deployed providers.
METHODS:After the BRG was implemented in January 2006, BRF data were prospectively collected in consecutive military casualties with >30% total body surface area (TBSA) burns (BRG Group). Baseline demographic data and fluid requirements for the first 24 hours of the burn resuscitation were collected from the BFS. Percentage full thickness TBSA burns, presence of inhalation injury, injury severity score, resuscitation-related abdominal compartment syndrome, and mortality were collected from our database. Individual charts were reviewed to determine the presence of extremity fasciotomies and myonecrosis. These results were compared with consecutive military casualties admitted during the 2-year- period before the system-wide implementation of the BRG (control group).
RESULTS:One hundred eighteen military casualties with burns >30% TBSA were admitted between January 2003 and June 2007, with n = 56 in the BRG group and n = 62 in the control group. The groups were different in age, but similar in %TBSA, %full thickness, presence of inhalation injury, and injury severity score. There was no difference in the rate of extremity fasciotomies or the incidence of myonecrosis between groups.
CONCLUSIONS:The composite endpoint of abdominal compartment syndrome and mortality was significantly lower in the BRG group compared with the control group (p = 0.03). Implementation of the BRG and system-wide standardization of burn resuscitation improved outcomes in severely burned patients. Utilization of the joint theater trauma system to implement system-wide guidelines is effective and can help improve outcomes.</description><subject>Adult</subject><subject>Burn Units</subject><subject>Burns - etiology</subject><subject>Burns - mortality</subject><subject>Burns - therapy</subject><subject>Cohort Studies</subject><subject>Emergency Treatment - standards</subject><subject>Guideline Adherence</subject><subject>Humans</subject><subject>Iraq War, 2003-2011</subject><subject>Military Personnel</subject><subject>Practice Guidelines as Topic</subject><subject>Retrospective Studies</subject><subject>Treatment Outcome</subject><subject>United States</subject><issn>0022-5282</issn><issn>1529-8809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkcFu1DAQhi0EokvLEyAhn7iljO3Edo7LqpSiokptOFteZ6IanKTYcau98-B42ZUqdQ4zo9H_j0bfEPKBwTmDVn3u1uewBSZQMM0kbOvavSIr1vC20hra12QFwHnVcM1PyLuUfgFAXQv9lpwwLZRkjV6Rv99nPy20u0e7YKRdtHm09G6XFhzp1fgQcMRpsYufJzoP9EuOE73FlJPzx-ll9j0GP2Ha6-P8WJqbvLh5LI2f6B0-YsSw--_Fnv7woVjjjm5syjYsHtMZeTPYkPD9sZ6Sn18vus236vrm8mqzvq6cqDWvnJIopcBWuxK25ryRHPWALSou0AK0PSjXOIu1kMJxOyhZEoMtZ71U4pR8OuwtZ_7JmBYz-uQwBDvhnJNRhU-jNS9CcRC6OKcUcTAP0Y_laMPA7OGbbm1ewi-uj8f1eTti_-w50i6C-iB4mkOhnX6H_ITRFPZhuTflPdAIJSoOoKEkVsH-g-IfqnKTXg</recordid><startdate>200802</startdate><enddate>200802</enddate><creator>Ennis, Jody L.</creator><creator>Chung, Kevin K.</creator><creator>Renz, Evan M.</creator><creator>Barillo, David J.</creator><creator>Albrecht, Michael C.</creator><creator>Jones, John A.</creator><creator>Blackbourne, Lorne H.</creator><creator>Cancio, Leopoldo C.</creator><creator>Eastridge, Brian J.</creator><creator>Flaherty, Steven F.</creator><creator>Dorlac, Warren C.</creator><creator>Kelleher, K S.</creator><creator>Wade, Charles E.</creator><creator>Wolf, Steven E.</creator><creator>Jenkins, Donald H.</creator><creator>Holcomb, John B.</creator><general>Lippincott Williams & Wilkins, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200802</creationdate><title>Joint Theater Trauma System Implementation of Burn Resuscitation Guidelines Improves Outcomes in Severely Burned Military Casualties</title><author>Ennis, Jody L. ; Chung, Kevin K. ; Renz, Evan M. ; Barillo, David J. ; Albrecht, Michael C. ; Jones, John A. ; Blackbourne, Lorne H. ; Cancio, Leopoldo C. ; Eastridge, Brian J. ; Flaherty, Steven F. ; Dorlac, Warren C. ; Kelleher, K S. ; Wade, Charles E. ; Wolf, Steven E. ; Jenkins, Donald H. ; Holcomb, John B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3482-c76e663e98cccca422562e8fe9e723ea009d07c5cae4363c2af762af10b21d673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adult</topic><topic>Burn Units</topic><topic>Burns - etiology</topic><topic>Burns - mortality</topic><topic>Burns - therapy</topic><topic>Cohort Studies</topic><topic>Emergency Treatment - standards</topic><topic>Guideline Adherence</topic><topic>Humans</topic><topic>Iraq War, 2003-2011</topic><topic>Military Personnel</topic><topic>Practice Guidelines as Topic</topic><topic>Retrospective Studies</topic><topic>Treatment Outcome</topic><topic>United States</topic><toplevel>online_resources</toplevel><creatorcontrib>Ennis, Jody L.</creatorcontrib><creatorcontrib>Chung, Kevin K.</creatorcontrib><creatorcontrib>Renz, Evan M.</creatorcontrib><creatorcontrib>Barillo, David J.</creatorcontrib><creatorcontrib>Albrecht, Michael C.</creatorcontrib><creatorcontrib>Jones, John A.</creatorcontrib><creatorcontrib>Blackbourne, Lorne H.</creatorcontrib><creatorcontrib>Cancio, Leopoldo C.</creatorcontrib><creatorcontrib>Eastridge, Brian J.</creatorcontrib><creatorcontrib>Flaherty, Steven F.</creatorcontrib><creatorcontrib>Dorlac, Warren C.</creatorcontrib><creatorcontrib>Kelleher, K S.</creatorcontrib><creatorcontrib>Wade, Charles E.</creatorcontrib><creatorcontrib>Wolf, Steven E.</creatorcontrib><creatorcontrib>Jenkins, Donald H.</creatorcontrib><creatorcontrib>Holcomb, John B.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The journal of trauma</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ennis, Jody L.</au><au>Chung, Kevin K.</au><au>Renz, Evan M.</au><au>Barillo, David J.</au><au>Albrecht, Michael C.</au><au>Jones, John A.</au><au>Blackbourne, Lorne H.</au><au>Cancio, Leopoldo C.</au><au>Eastridge, Brian J.</au><au>Flaherty, Steven F.</au><au>Dorlac, Warren C.</au><au>Kelleher, K S.</au><au>Wade, Charles E.</au><au>Wolf, Steven E.</au><au>Jenkins, Donald H.</au><au>Holcomb, John B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Joint Theater Trauma System Implementation of Burn Resuscitation Guidelines Improves Outcomes in Severely Burned Military Casualties</atitle><jtitle>The journal of trauma</jtitle><addtitle>J Trauma</addtitle><date>2008-02</date><risdate>2008</risdate><volume>64</volume><issue>2 Suppl</issue><spage>S146</spage><epage>S152</epage><pages>S146-S152</pages><issn>0022-5282</issn><eissn>1529-8809</eissn><abstract>BACKGROUND:Between March 2003 and June 2007, our burn center received 594 casualties from the conflicts in Iraq and Afghanistan. Ongoing acute burn resuscitation as severely burned casualties are evacuated over continents is very challenging. To help standardize care, burn resuscitation guidelines (BRG) were devised along with a burn flow sheet (BFS) and disseminated via the new operational Joint Theater Trauma System to assist deployed providers.
METHODS:After the BRG was implemented in January 2006, BRF data were prospectively collected in consecutive military casualties with >30% total body surface area (TBSA) burns (BRG Group). Baseline demographic data and fluid requirements for the first 24 hours of the burn resuscitation were collected from the BFS. Percentage full thickness TBSA burns, presence of inhalation injury, injury severity score, resuscitation-related abdominal compartment syndrome, and mortality were collected from our database. Individual charts were reviewed to determine the presence of extremity fasciotomies and myonecrosis. These results were compared with consecutive military casualties admitted during the 2-year- period before the system-wide implementation of the BRG (control group).
RESULTS:One hundred eighteen military casualties with burns >30% TBSA were admitted between January 2003 and June 2007, with n = 56 in the BRG group and n = 62 in the control group. The groups were different in age, but similar in %TBSA, %full thickness, presence of inhalation injury, and injury severity score. There was no difference in the rate of extremity fasciotomies or the incidence of myonecrosis between groups.
CONCLUSIONS:The composite endpoint of abdominal compartment syndrome and mortality was significantly lower in the BRG group compared with the control group (p = 0.03). Implementation of the BRG and system-wide standardization of burn resuscitation improved outcomes in severely burned patients. Utilization of the joint theater trauma system to implement system-wide guidelines is effective and can help improve outcomes.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>18376158</pmid><doi>10.1097/TA.0b013e318160b44c</doi></addata></record> |
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| ispartof | The journal of trauma, 2008-02, Vol.64 (2 Suppl), p.S146-S152 |
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| subjects | Adult Burn Units Burns - etiology Burns - mortality Burns - therapy Cohort Studies Emergency Treatment - standards Guideline Adherence Humans Iraq War, 2003-2011 Military Personnel Practice Guidelines as Topic Retrospective Studies Treatment Outcome United States |
| title | Joint Theater Trauma System Implementation of Burn Resuscitation Guidelines Improves Outcomes in Severely Burned Military Casualties |
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