0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comment & Response |

A Military-Specific Injury Scoring System to Aid in Understanding the Golden Hour

Michael C. Reade, MBBS, MPH, DPhil, FCICM1
[+] Author Affiliations
1Australian Defence Force Joint Health Command and University of Queensland, Queensland, Australia
JAMA Surg. 2016;151(5):491. doi:10.1001/jamasurg.2015.4915.
Text Size: A A A
Published online

Extract

To the Editor The study by Kotwal et al1 demonstrating a lower case fatality rate and (adjusted for Injury Severity Score) a lower killed in action rate after the 2009 mandate to transport wounded US military casualties from the battlefield in Afghanistan is a resounding endorsement of the potential benefit of policy change at the highest level. While transporting critically wounded patients to the hospital quickly makes logical sense, there remain opportunities for more nuanced study. Presumedly owing to the changing nature of the conflict, the proportion of patients wounded by explosion increased from 55.0% before to 67.0% after (P < .001) the intervention.1 The Injury Severity Score is an imperfect instrument to adjust for risk of death at time of injury, even in homogenous populations,2 but is particularly problematic when comparing patients with penetrating blast-fragmentation trauma with patients with other types of wounds. Blast fragmentation typically involves penetration of several body parts with low-energy debris, increasing the anatomically based Injury Severity Score without necessarily affecting risk of death as much as might other types of penetrating trauma. An increasing proportion of blast-fragmentation wounds may account for the decreasing case fatality rate, and Injury Severity Score–adjusted results are a relatively weak argument against this possibility. The observed case fatality rate inflection point after the “golden hour” mandate does suggest an additional effect of quicker prehospital times, but it would be interesting to know whether there was a similar inflection point in the trauma mechanism around this time.

Topics

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

January 1, 2016
Russ S. Kotwal, MD, MPH; Jeffrey T. Howard, PhD; Jean A. Orman, ScD, MPH; Bruce W. Tarpey, BS; Jeffrey A. Bailey, MD; Howard R. Champion, FRCS; Robert L. Mabry, MD; John B. Holcomb, MD; Kirby R. Gross, MD
1Joint Trauma System, United States Army Institute of Surgical Research, Joint Base San Antonio–Ft Sam Houston, Texas2Uniformed Services University of the Health Sciences, Bethesda, Maryland3Texas A&M Health Science Center College of Medicine, College Station
1Joint Trauma System, United States Army Institute of Surgical Research, Joint Base San Antonio–Ft Sam Houston, Texas
1Joint Trauma System, United States Army Institute of Surgical Research, Joint Base San Antonio–Ft Sam Houston, Texas2Uniformed Services University of the Health Sciences, Bethesda, Maryland
2Uniformed Services University of the Health Sciences, Bethesda, Maryland
4Center for Translational Injury Research, The University of Texas Medical School at Houston
JAMA Surg. 2016;151(1):15-24. doi:10.1001/jamasurg.2015.3104.
May 1, 2016
Russ S. Kotwal, MD, MPH; Howard R. Champion, FRCS; Kirby R. Gross, MD
1Trauma Care Delivery, Joint Trauma System, United States Army Institute of Surgical Research, Joint Base San Antonio–Ft Sam Houston, Texas2Uniformed Services University of the Health Sciences, Bethesda, Maryland3Texas A&M Health Science Center College of Medicine, University, College Station
2Uniformed Services University of the Health Sciences, Bethesda, Maryland
1Trauma Care Delivery, Joint Trauma System, United States Army Institute of Surgical Research, Joint Base San Antonio–Ft Sam Houston, Texas2Uniformed Services University of the Health Sciences, Bethesda, Maryland
JAMA Surg. 2016;151(5):491-492. doi:10.1001/jamasurg.2015.4895.
CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

153 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Jobs
brightcove.createExperiences();