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Publications

The following articles are based on DoD Trauma Registry data and/or authored by JTS data analysts, JTS epidemiologists and JTS leaders, including prominent combat casualty surgeons and trauma care providers.

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Janak JC, Mazuchowski EL, Kotwal RS, Stockinger ZT, Howard JT, Butler FK, Sosnov JA, Gurney JM, Shackelford SA. Patterns of anatomic injury in critically injured combat casualties: a network analysis. Sci Rep. 2019 Sep 24;9(1):13767. doi: 10.1038/s41598-019-50272-3. PubMed PMID: 31551454.

Johnson ES, Gaydos SJ, Pavelites JJ, Kotwal RS, Houk JE. U.S. Army parachute mishap fatalities: 2010-2015. Aerosp Med Hum Perform. 2019 Jul 1;90(7):637-642. doi: 10.3357/AMHP.5329.2019. PubMed PMID: 31227038.

Kotwal RS, Mazuchowski EL, Stern CA, Montgomery HR, Janak JC, Howard JT, Butler FK, Holcomb JB, Eastridge BJ, Gurney JM, Shackelford SA. A descriptive study of U.S. Special Operations Command fatalities, 2001 to 2018. J Trauma Acute Care Surg. 2019 Sep;87(3):645-657. doi: 10.1097/TA.0000000000002354. PubMed PMID: 31045733.

Harrison WY, Wardian JL, Sosnov JA, Kotwal RS, Butler FK, Stockinger ZT, Shackelford SA, Gurney JM, Spott MA, Finelli LN, Mazuchowski EL, Smith DJ, Janak JC. Recommended medical and non-medical factors to assess military preventable deaths: subject matter experts provide valuable insights. J R Army Med Corps. 2019 Apr 29. pii: jramc-2019-001193. doi: 10.1136/jramc-2019-001193. [Epub ahead of print] PubMed PMID: 31036745.

Howard JT, Kotwal RS, Stern CA, Janak JC, Mazuchowski EL, Butler FK, Stockinger ZT, Holcomb BR, Bono RC, Smith DJ. Use of combat casualty care data to assess the U.S. military trauma system during the Afghanistan and Iraq Conflicts, 2001-2017. JAMA Surg. 2019 Jul 1;154(7):600-608. doi: 10.1001/jamasurg.2019.0151.Erratum in: JAMA Surg. 2019 May 1. PubMed PMID: 30916730; PubMed Central PMCID: PMC6583837.

Schweizer MA, Janak JC, Graham B, Mazuchowski EL, Gurney JM, Shackelford SA, Stockinger ZT, Monchal T. Nonfatal motor vehicle related injuries among deployed US Service members: Characteristics, trends, and risks for limb amputations. J Trauma Acute Care Surg. 2019 Oct;87(4):907-914. doi: 10.1097/TA.0000000000002436. PubMed PMID: 31589195.

Glaser JJ, Fisher AD, Shackelford SA, Butler F, Rasmussen TE. A contemporary report on US military guidelines for the use of whole blood and resuscitative endovascular balloon occlusion of the aorta. J Trauma Acute Care Surg. 2019 Jul;87(1S Suppl 1):S22-S27. doi: 10.1097/TA.0000000000002301. PubMed PMID: 31246902.

Mackenzie CF, Shackelford SA, Tisherman SA, Yang S, Puche A, Elster EA, Bowyer MW; Retention and Assessment of Surgical Performance Group of Investigators. Critical errors in infrequently performed trauma procedures after training. Surgery. 2019 Nov;166(5):835-843. doi: 10.1016/j.surg.2019.05.031. Epub 2019 Jul 25. PubMed PMID: 31353081.

Anderson KL, Mora AG, Bloom AD, Maddry JK, Bebarta VS. Cardiac massage for trauma patients in the battlefield: An assessment for survivors. Resuscitation (2019).

Johnston LR, Bradley MJ, Rodriguez CJ, Mcnally MP, Elster EA, Duncan JE. Ostomy usage for colorectal trauma in combat casualties. World Journal of Surgery 43, no. 1 (2019): 169-174.

Lee L, Dickens N, Mitchener T, Qureshi I, Cardin S, Simecek J. The burden of dental emergencies, oral-maxillofacial, and cranio-maxillofacial injuries in U.S. military personnel. Mil Med (2019).

Schauer SG, Naylor JF, Long AN, Mora AG, Le TD, Maddry JK, April MD Analysis of injuries and prehospital interventions sustained by females in the Iraq and Afghanistan combat zones. Prehospital emergency care(2019): 1-8.

Schauer SG, Naylor JF, Maddry JK, Hinojosa-Laborde C, April MD. Trends in prehospital analgesia administration by U.S. forces from 2007 through 2016. Prehospital Emergency Care 23, no. 2 (2019): 271-276.

Schauer SG, Naylor JF, Oliver JJ, Maddry JK, April MD. An analysis of casualties presenting to military emergency departments in Iraq and Afghanistan. The American Journal of Emergency Medicine 37, no. 1 (2019): 94-99.

Schauer SG, Naylor JF, Bellamy MA, Maddry JK, April MD. A descriptive analysis of causalities undergoing CASEVAC from the point-of-injury in the Department of Defense Trauma Registry. Mil Med (2019).

Schauer SG, April MD, Naylor JF, Maddry JK, Keen DE, Cunningham CW, Becker TE, Walters T, Keenan S. A descriptive analysis of casualties evacuated from the Africa area of operations. African Journal of Emergency Medicine (2019): S43-S46.

Schweizer MA., Janak JC, Stockinger ZT, Monchal T. Description of trauma among French service members in the Department of Defense Trauma Registry: understanding the nature of trauma and the care provided. Mil Med Res. 2019 Feb 27;6(1):7. doi: 10.1186/s40779-019-0197-6. Erratum in: Mil Med Res. 2019 Jul 28;6(1):

Sharrock, AE, Remick KN, Midwinter MJ, Rickard RF. Combat vascular injury: influence of mechanism of injury on outcome. Injury 50, no. 1 (2019): 125-130.

Stern CA, Stockinger ZT, Todd WE, Gurney JM. An analysis of orthopedic surgical procedures performed during U.S. combat operations from 2002 to 2016. Mil Med. 2019 Apr 24. pii: usz093.

Stewart, L, Shaikh F, Bradley W, Lu D, Blyth DM, Petfield JL, Whitman TJ, Krauss M, Greenberg L, Tribble DR. Combat-related extremity wounds: injury factors predicting early onset infections. Mil Med 184, no. Supplement_1 (2019): 83-91.

Spott MA, Kurkowski CR, Stockinger ZT. The Joint Trauma System: history in the making. Mil Med 183, no. suppl_2 (2018): 4-7.

Pusateri AE, Butler FK, Shackelford SA, Sperry JL, Moore EE, Cap AP, Taylor AL, Homer MJ, Hoots WK, Weiskopf RB, Davis MR. The need for dried plasma – a national issue. Transfusion. 2019 Apr;59(S2):1587-1592. doi: 10.1111/trf.15261. PubMed PMID: 30980738.

Staudt AM, Savell SC, Biever KA, Trevino JD, Valdez-Delgado KK, Suresh M, Gurney JM, Shackelford SA, Maddry JK, Mann-Salinas EA. En route critical care transfer from a role 2 to a role 3 medical treatment facility in Afghanistan. Crit Care Nurse. 2018 Apr;38(2):e7-e15. doi: 10.4037/ccn2018532. PubMed PMID: 29606685.

Miller L, Pacheco GJ, Janak JC, Grimm RC, Dierschke NA, Baker J, Orman JA. Causes of death in military working dogs during Operation Iraqi Freedom and Operation Enduring Freedom, 2001-2013. Mil Med. 2018 Sep 1;183(9-10):e467-e474. doi: 10.1093/milmed/usx235. PubMed PMID: 29547926.

Janak JC, Davidson AJ, Sosnovc JA, Stewart IJ, Howard JT. Response to 'Presenting hypertension, burn injury, and mortality in combat casualties: methodological issues'. Burns. 2018 Aug;44(5):1373-1375. doi: 10.1016/j.burns.2017.11.017. Epub 2018 May 10. PubMed PMID: 29753453.

Redman TT, Mayberry KE, Mora AG, Benedict BA, Ross EM, Mapp JG, Kotwal RS. Survey of casualty evacuation missions conducted by the 160th Special Operations Aviation Regiment during the Afghanistan conflict. J Spec Oper Med. Summer 2018;18(2):79-85. PubMed PMID: 29889961.

Butler FK Jr, Holcomb JB, Shackelford S, et al. Advanced resuscitative care in tactical combat casualty care: TCCC Guidelines Change 18-01:14 Oc 2018. J Spec Oper Med. Winter 2018;18(4):37-55. PubMed PMID: 30566723.

Reed JR, Carman MJ, Titch FJ, Kotwal RS. Implementation and evaluation of a first-responder bleeding-control training program in a rural police department. J Spec Oper Med. Fall 2018;18(3):57-61. PubMed PMID: 30222838.

Balzano FL, Hudak SJ. Military genitourinary injuries: past, present, and future. Translational andrology and urology 7, no. 4 (2018): 646.

Barnard EBG, Smith JE. Non-compressible torso haemorrhage: the new holy grail for further improvement in trauma survival. Journal of the Royal Naval Medical Service 104, no. 2 (2018)

Blackburn MB, April MD, Brown DJ, DeLorenzo RA, Ryan KL, Blackburn AN, Schauer SG. Prehospital airway procedures performed in trauma patients by ground forces in Afghanistan. J Trauma Acute Care Surg85, no. 1S (2018): S154-S160. July, 2018

Cannon JW, Neff LP, Pidcoke HF, Aden JK, Spinella PC, Johnson MA, Cap AP, Borgman MA. The evolution of pediatric transfusion practice during combat operations 2001-2013. J Trauma Acute Care Surg vol 84, no. 6S (Jun 2018): S69-S76.

Delgado RE., Peacock K, Elizondo B, Wells M, Grafman JH, Pugh MJ. A family's affair: caring for veterans with penetrating traumatic brain injury. Mili Med vol 183, no. suppl_1 (Mar-Apr 2018): 379-385.

Donias A, Chalupa RL, Rivera JC, Johnson AE. Contralateral knee injuries in military service members with unilateral lower-extremity amputations. JBJS Journal of Orthopaedics for Physician Assistants, no. 4 ( Oct-Dec, 2018): e33.

Dukes SF, Maupin GM, Thomas ME, Mortimer DL. Pressure injury development in patients treated by critical care air transport teams: a case-control study. Critical Care Nurse vol 38, no. 2 Apr, 2018: 30-36.

Faulk T, Walker LE, Howard JT, Janak JC, Sosnov JA, Stewart IJ. Rhabdomyolysis among critically ill combat casualties: long-term outcomes. Am J Nephrol. 2018; 48(6):399-405. doi: 10.1159/000494337. Epub 2018 Nov 14. PubMed PMID: 30428460.

Hill GJ, April MD, Maddry JD, Schauer SG. Prehospital ketamine administration to pediatric trauma patients with head injuries in combat theaters. J Emerg Med, 22 Oct 2018.

Johnson MA, Borgman MA, Cannon JW, Kuppermann N, Neff LP. Severely elevated blood pressure and early mortality in children with traumatic brain injuries: the neglected end of the spectrum. Western Journal of Emergency Medicine vol 19, no. 3 (2018): 452.

Kauvar DS, Miller D, Walters TJ. Tourniquet use is not associated with limb loss following military lower extremity arterial trauma. J Trauma Acute Care Surg vol 85, no. 3 (2018): 495-499

Kuckelman J, Cuadrado D, Martin M. Thoracic trauma: a combat and military perspective: current trauma reports vol 4, no. 1 (2018): 77-87.

Maddry JK, Mora AG, Savell SC, Perez CA, Mason PE, Aden JK, Bebarta VS. Impact of Critical Care Air Transport Team (CCATT) ventilator management on combat mortality. J Trauma Acute Care Surg. 2018 Jan;84(1):157-164.

Maddry JK., Mora A, Savell S, Reeves LV, Perez CA, Bebarta V. An evaluation of TACEVAC pre-hospital care and its effect on clinical outcomes: evidence to support future clinical practice guidelines. No. M-10373. 59 Medical Wing Science and Technology JBSA United States, 2018.

Maddry JK, Anderson K, Mora A Determining predictors of survival among traumatic cardiopulmonary arrest patients in a combat theater environment. No. 18253. 59 MDW San Antonio United States, 2018.

Maddry J, Mora A, Savell S, Perez C, Mason P, Aden J, Bebarta V. Mechanical ventilation methods in transport of critically injured and ill patients by CCATT. 59th Medical Wing Science and Technology JBSA United States, 2018.

Naylor JF, Burbank K, April MD, Wenke JC, Maddry JK, Schauer SG. Effects of prehospital wound prophylaxis in Iraq and Afghanistan on mortality, Journal of Trauma & Treatment vol 7, no. 1 (2018): 1000424.

Naylor JF, April MD, Roper JL, Hill GJ, Clark P, Schauer SG. Emergency department imaging of pediatric trauma patients during combat operations in Iraq and Afghanistan. Pediatric radiology vol 48, no. 5 (2018): 620-625.

Neal CJ, McCafferty RR, Freedman B, Helgeson MD, Rivet D, Gwinn DE, Rosner MK. Cervical and thoracolumbar spine injury evaluation, transport, and surgery in the deployed setting. Mil Med vol 183, no. suppl_2 (2018): 83-91.

Patel JA, White JM, White PW, Rich NM, Rasmussen TE. A contemporary, 7-year analysis of vascular injury from the war in Afghanistan. J. Vasc. Surg, no. 6 (2018): 1872-1879.

Penn-Barwell JG, Bishop JRB, Midwinter MJ. Refining the trauma and injury severity score (TRISS) to measure the performance of the UK combat casualty care system. Mil Med vol 183, no. 9-10 (2018): e442-e447.

Pollock BH. Trauma Outcomes and UroGenital Health in OEF/OIF (TOUGH)-a retrospective cohort study with long-term follow-up. University of California, Davis Davis United States, 2018.

Pugh MJ, Swan AA, Carlson KF, Jaramillo CA, Eapen BC, Dillahunt-Aspillaga C, Amuan ME et al. Traumatic brain injury severity, comorbidity, social support, family functioning, and community reintegration among Veterans of the Afghanistan and Iraq wars. Archives of physical medicine and rehabilitation vol 99, no. 2 (2018): S40-S49.

Purcell RL, Donohue MA, Saxena SK, Gordon WT, Lewandowski LL. Combat-related acetabular fractures: outcomes of open versus closed injuries. Injury vol 49, no. 2 (2018): 290-295.

Rasmussen TE. Actionable information to reduce the burden of nonbattle injury in deployed US service personnel. JAMA surgery vol 153, no. 9 (2018): 808-808.

Schauer SG, Arana AA, Naylor JF, Hill GJ, April MD. Prehospital analgesia for pediatric trauma patients in Iraq and Afghanistan. Prehospital Emergency Care 22, no. 5 (2018): 608-613.

Schauer SG, Hill GJ, Connor RE, Oh SJ, April MD. The pediatric resuscitative thoracotomy during combat operations in Iraq and Afghanistan–A retrospective cohort study. Injury vol 49, no. 5 (2018): 911-915.

Schauer SG, Naylor JF, Hill GJ, Arana AA, Roper JL, April MD. Association of prehospital intubation with decreased survival among pediatric trauma patients in Iraq and Afghanistan. J Emerg Med vol 36, no. 4 (2018): 657-659.

Schauer SG, Naylor JF, Maddry JK, Beaumont DM, Cunningham CW, Blackburn MB, April MD. Prehospital airway management in Iraq and Afghanistan: a descriptive analysis. Southern Medical Journal vol 111, no. 12 (2018): 707-713.

Schauer SG, Naylor JF, April MD, Fisher MD, Cunningham CW, Fernandez JRD, Shreve BP, Bebarta VS. Prehospital resuscitation performed on hypotensive trauma patients in Afghanistan: The Prehospital Trauma Registry Experience. Mil Med (2018).

Schauer SG, Naylor JF, April MD, Thronson EE, Maddry JK, Becker TE, Gross KR. The first 30 months experience in the non-doctrinal operation inherent resolve medical theater. Mil Med (2018).

Schauer SG, April MD, Hill GJ, Naylor JF, Borgman MA, De Lorenzo RA. Prehospital interventions performed on pediatric trauma patients in Iraq and Afghanistan. Prehospital Emergency Care vol 22, no. 5 (2018): 624-629.

Schauer SG, April MD, Naylor JF, Maddry JK, Arana AA, Dubick MA, Fisher AD, Cunningham CW, Pusateri AE. Prehospital application of hemostatic agents in Iraq and Afghanistan. Prehospital Emergency Care vol 22, no. 5 (2018): 614-623.

Skube ME, Mallery Q, Lusczek E, Elterman J, Spott MA, Beilman GJ. Characteristics of combat-associated small bowel injuries. Mil Med vol 183, no. 9-10 (2018): e454-e459.

Tennent DJ, Polfer EM, Sgromolo NM, Krueger CA, Potter BK. Characterization of disability following traumatic through knee and transfemoral amputations. Injury vol 49, no. 6 (2018): 1193-1196.

Tribble DR, Lewandowski LR, Potter BK, Petfield JL, Stinner DJ, Ganesan A, Krauss M, Murray CK, Trauma Infectious Disease Outcomes Study Group. Osteomyelitis risk factors related to combat trauma open tibia fractures: a case–control analysis. Journal of Orthopaedic Trauma, Sep 2018. 32(9), pp.e344-e353.

Tribble DR, Krauss MR, Murray CK, et al. Epidemiology of trauma-related infections among a combat casualty cohort after initial hospitalization: the trauma infectious disease outcomes study. Surgical infections vol 19, no. 5 (2018): 494-503.

Weintrob AC, Murray CK, Xu J et al. Early infections complicating the care of combat casualties from Iraq and Afghanistan. Surgical infections 19, no. 3 (2018): 286-297.

Janak JC, Clemens MS, Howard JT, Le TD, Cancio LC, Chung KK, Gurney JM, Sosnov JA, Stewart IJ. Using the injury severity score to adjust for comorbid trauma may be double counting burns: implications for burn research, Burns, Mar 2018.

  • This study compares differences in the estimated mortality risk of burn trauma using the traditional injury severity score calculation and the non-burn injury severity score to examine how separating out the risk attributable to the burn injury versus other trauma changes the interpretation and clinical assessment.

Blackman VS, Walrath BD, Reeves LK, Mora AG, Maddry JK, Stockinger ZT, En route care provided by US Navy nurses in Iraq and Afghanistan, Critical-Care Nurse, 02 Apr 2018.

  • US Navy nurses provide en route care for critically injured combat casualties without having a formal program for training, utilization, or evaluation. Little is known about missions supported by Navy nurses. This study characterizes the number and types of patients transported and skill sets required by Navy nurses during combat support deployments.

Staudt AM, Savell, SC, Biever KA, Trevino JD, Valdez-Delgado KK, Suresh M, Gurney JM, Shackelford SA, Maddry JK, Mann-Salinas EA. En route critical care transfer from a Role 2 to a Role 3 medical treatment facility in Afghanistan, American Association of Critical-Care Nurses, Apr 2018.

  • No reports have been published about en route care of patients during transfer from a forward surgical facility (Role 2) to a combat support hospital (Role 3) for comprehensive care. This article describes patients transferred from a Role 2 to a Role 3 US military treatment facility in Afghanistan.

Nessen SC, Gurney JM, Rasmussen TE, Cap AP, Mann-Salinas E, Le TD, Shackelford SA, Remick KN, Akers K, Eastridge B, Jenkins D, Stockinger ZT, Murray CK, Gross, K, Seery J, Mabry R, Holcomb JB, Unrealized potential of the US Military Battlefield Trauma System: DOW rate is higher in Iraq and Afghanistan than in Vietnam, but CFR and KIA rate are lower, Journal of Trauma and Acute Care Surgery, Jul 2018.

  • This paper reports that although case fatality rate (CFR) and %Killed in Action (%KIA) rate have improved, the died of wound percentage (%DOW) has increased. The authors also report the relationship of the CFR, %DOW, %KIA, and Injury Severity Score over time for Operations Enduring and Iraqi Freedom.

Orman JA, Parker JA, Stockinger ZT, Nemelka KW, The Military Working Dog Trauma Registry Strategic Planning Group, The need for a combat casualty care research program and trauma registry for military working dogs, Mil Med, 15 Jun 2018.

  • This article provides an overview of the challenges facing successful combat casualty care of military working dogs (MWDs) and the efforts underway to gather and analyze data to improve survival rates of MWDs on the battlefield.

Nnamani NS, Pugh JJ, Amuan ME, Eapen BE, Hudak SJ, Liss MA, Orman JA, Outcomes of genitourinary injury in US Iraq and Afghanistan War veterans receiving care from the Veterans Health Administration, Mil Med, 14 Aug 2018.

  • In the recent conflicts, unprecedented numbers of US service personnel have survived with genitourinary (GU) injury, but few reports have focused on outcomes of these injuries. Outcomes of combat-related GU injury were investigated in wounded US male veterans of Operations Enduring/Iraqi Freedom and New Dawn receiving Veterans Health Administration care.

Kotwal RS, Staudt AM, Mazuchowski EL, Gurney JM, Shackelford SA, Butler FK, Stockinger ZT, Holcomb JB, Nessen SC, Mann-Salinas EA. A US military Role 2 forward surgical team database study of combat mortality in Afghanistan, J Trauma Acute Care Surg, 30 May 2018.

  • Overview of the development of a database to capture Role 2 data from US military Role 2 surgical teams deployed to forward positions in Afghanistan on behalf of the battlefield trauma system.

Janak JC, Stockinger ZT, Mazuchowski E, Kotwal R, Sosnov J, Montgomery H, Butler FK, Shackelford SA, Gurney JM, Spott MA, Finelli L, Smith DJ. Military preventable death conceptual framework: a systematic approach for reducing battlefield mortality, Mil Med, 05 Sep 2018.

  • This manuscript presents the conceptual framework that is guiding our effort to establish the first ever battle-related mortality surveillance system with preventable death metrics and opportunities to improve the trauma care system.

Kotwal RS, Scott LLF, Janak JC, Tarpey BW, Howard JT, Mazuchowski EL, Butler FK, Shackelford SA, Gurney JM, Stockinger ZT. The effect of prehospital transport time, injury severity, and blood transfusion on survival of US military casualties in Iraq, J Trauma Acute Care Surg, Jul 2018.

  • This study sought to evaluate unique aspects inherent to the Iraq conflict and compare these findings to the Afghanistan conflict.

Howard JT, Sosnov JA, Janak JC, Gundlapalli AV, Pettey WB, Walker LE, Stewart IJ. Associations of initial injury severity and posttraumatic stress disorder diagnoses with long-term hypertension risk after combat injury, Hypertension, 19 Mar 2018.

  • This study sought to (1) estimate the prevalence and incidence of posttraumatic stress disorder (PTSD) within a severely injured military cohort, (2) assess the association between the presence and chronicity of PTSD and hypertension, and (3) determine whether or not initial injury severity score and PTSD are independent risk factors for hypertension.

Janak JC, Sosnov JA, Bares JM, Stockinger ZT, Montgomery HR, Kotwal RS, Butler FK, Shackelford SA, Gurney JM, Spott MA, Finelli LN, Mazuchowski EL, Smith DJ. Comparison of military and civilian methods for determining potentially preventable deaths: A systematic review, JAMA Surg, 01 Apr 2018.

  • This paper compares military and civilian preventable death determination methods to understand the existing best practices for evaluating preventable death.

Miller L, Pacheco GJ, Janak JC, Grimm RC, Dierschke NA, Baker J, Orman JA. Causes of death in military working dogs during Operation Iraqi Freedom and Operation Enduring Freedom, 2001-2013, Mil Med, 14 Mar 2018.

  • This study is the most comprehensive study to date that reports causes of death of military working dogs deployed to Operation Iraqi Freedom and Operation Enduring Freedom.

Reed AM, Janak JC, Orman JA, Hudak SJ. Genitourinary (GU) injuries among female US service members during Operation Iraqi Freedom and Operation Enduring Freedom: Findings from the Trauma Outcomes and Urogenital Health (TOUGH) Project, Mil Med, 01 Jul 2018.

  • This study describes the epidemiology of GU injuries among female US service members during Operation Iraqi Freedom and Operation Enduring Freedom and understand the potential for increased female GU injuries in future conflicts and the long-term sequelae from these injury patterns.

Ferencz SE, Davidson AJ, Howard JT, Janak JC, Sosnov JA, Chung KK, Stewart IJ. Coagulopathy and mortality in combat casualties: do the kidneys play a role? Mil Med, 03 Apr 2018.

  • This study explores how the presence of acute traumatic coagulopathy influences the development of acute kidney injury and may mediate mortality in combat casualties.

Davidson AJ, Ferencz SE, Sosnov JA, Howard JT, Janak JC, Chung KK, Stewart IJ. Presenting hypertension, burn injury, and mortality in combat casualties, Burns, Mar 2018.

  • The effect of presenting hypertension is poorly studied in combat casualties. This study hypothesized that elevated mean arterial pressure on presentation to combat hospitals would be associated with poor outcomes.

Le TD, Gurney JM, Nnamani NS, Gross KR, Chung KK, Stockinger ZT, Nessen SC, Pusateri AE, Akers KS. A 12-Year analysis of nonbattle injury among US service members deployed to Iraq and Afghanistan, JAMA Surg, Sep 2018.

  • This paper documents the significance and magnitude of nonbattle injury in the deployed environment, and how the prevention of nonbattle injury could reduce a portion of the injury burden sustained during war.

Stockinger ZT, Turner CA, Gurney JM. Abdominal trauma surgery during recent US combat operations from 2002 to 2016, J Trauma Acute Care Surg, Jul 2018.

  • Abdominal surgery constitutes approximately 13% of surgical procedures performed for combat injuries. This study examines the frequencies and type of abdominal surgical procedures performed during recent US Military operations.

Turner CA, Stockinger ZT, Bell RS, Gurney JM. Neurosurgical workload during US combat operations: 2002 to 2016, J Trauma Acute Care Surg, Jul 2018.

  • This study examines the neurosurgical workload in Iraq and Afghanistan in order to inform the future predeployment neurosurgical training needs of nonneurosurgical providers.

Turner CA, Orman JA, Stockinger ZT, Hudak SJ. Genitourinary surgical workload at deployed US facilities in Iraq and Afghanistan, 2002-2016, Mil Med, 13 Jun 2018.

  • This paper describes in detail the genitourinary surgical workload during 15 years of combat operations to better understand the training and skills maintenance needs for genitourinary procedures.

Howard JT, Kotwal RS, Santos AR, Martin MJ, Stockinger ZT. Re-examination of a Battlefield Trauma Golden Hour Policy, J Trauma Acute Care Surg, Jan 2018.

  • This retrospective analysis evaluates proposed explanations for observed KIA reduction after a mandate by Secretary of Defense Robert M. Gates that transport of injured service members occur within 60 minutes.

Turner CA, Stockinger ZT, Gurney JM. Vascular surgery during U.S. combat operations from 2002 to 2016: Analysis of vascular procedures performed to inform military training, J Trauma Acute Care Surg, Jul 2018.

  • This study examines the frequency and type of vascular surgical procedures performed during recent US Military operations from 2002 to 2016.

Shackelford SA, Del Junco DJ. Prehospital blood product transfusion and combat injury survival-Reply, JAMA, 20 Mar 2018.

  • In Reply: Although a retrospective study cannot rule out unmeasured confounding, we respectfully disagree with Dr. David and colleagues that the reported between-group mortality difference "may be related to the quality of prehospital resuscitation rather than prehospital transfusion."

Shackelford SA, del Junco DJ, Reade MC, Bell R, Becker T, Gurney JM, McCafferty R, Marion DW. Association of time to craniectomy with survival in patients with combat-related brain injury, Neurosurgical Focus: Journal of Neurosurgery, 01 Dec 2018.

Granite G, Pugh K, Chen H, Longinaker N, Garofalo E, Shackelford S, Shalin V, Puche A, Pasley J, Sarani B, Henry S, Bowyer M, Mackenzie C. Assessment of anatomical knowledge and core trauma competency vascular skills, Mil Med, Mar 2018.

  • This study reports residents' self-confidence evaluated before and after advanced surgical skills for exposure in trauma cadaver-based training, and 12-18 months later

Woolley T, Thompson P, Kirkman E, Reed R, Ausset S, Beckett A, Bjerkvig C, Cap AP, Coats T, Cohen M, Despasquale M, Dorlac W, Doughty H, Dutton R, Eastridge B, Glassberg E, Hudson A, Jenkins D, Keenan S, Martinaud C, Miles E, Moore E, Nordmann G, Prat N, Rappold J, Reade MC, Rees P, Rickard R, Schreiber M, Shackelford SA, Skogran Eliassen H, Smith J, Smith M, Spinella P, Strandenes G, Ward K, Watts S, White N, Williams S. Trauma hemostasis and oxygenation research network position paper on the role of hypotensive resuscitation as part of remote damage control resuscitation, J Trauma Acute Care Surg, Jun 2018.

  • This review aims to challenge the current concept of hypotensive resuscitation when applied to remote damage control resuscitation in either a civilian or military situation to suggest targets for resuscitation in this situation, and to act as a call for research into specific questions.

Mackenzie CF, Bowyer MW, Henry S, Tisherman SA, Puche A, Chen H, Shalin V, Pugh K, Garofalo E, Shackelford SA; Retention and Assessment of Surgical Performance Group of Investigators. Cadaver-based trauma procedural skills training: skills retention 30 months after training among practicing surgeons in comparison to experts or more recently trained residents, J Am Coll Surg, 22 Aug 2018.

  • Prospective study measured and compared technical skills for trauma core competencies at mean 14 months (38 residents), 30 months (35 practicing surgeons), and 46 months (10 experts) after training to determine if skill degradation occurs with time.

Kotwal RS, Staudt AM, Trevino JD, Valdez-Delgado KK, Le TD, Gurney JM, Sauer SW, Shackelford SA, Stockinger ZT, Mann-Salinas EA. A review of casualties transported to Role 2 medical treatment facilities in Afghanistan, Mil Med, 01 Mar 2018.

  • A retrospective review and descriptive analysis of trauma patients transported from Role 1 entities to Role 2 facilities in Afghanistan from 2008 to 2014 found casualties to be diverse in affiliation and delivered by various types and modes of transport.

Staudt A, Gurney JM, Valdez-Delgado K, Suresh M, Trevino J, Le T, Seery J, Shackelford SA, Nessen S, Mann-Salinas E. Factors associated with trauma patients' length of stay at Role 2 facilities in Afghanistan, October 2009 to September 2014, J Trauma Acute Care Surg, Jul 2018.

  • A secondary data analysis of the Joint Trauma System Role 2 Database. Logistic regression was used to determine factors associated with extended length of stay at Role 2.

Galvagno SM Jr, Mabry RL, Maddry J, Kharod CU, Walrath BD, Powell E, Shackelford SA. Measuring US Army medical evacuation: metrics for performance improvement, J Trauma Acute Care Surg, Jan 2018.

  • A demonstration project to advance a model of quality assurance surveillance and medical direction for prehospital MEDEVAC providers within the Joint Trauma System.

Rodriguez CJ, Tribble DR, Malone DL, Murray CK, Jessie EM, Khan M, Fleming ME, Potter BK, Gordon WT, Shackelford SA. Treatment of suspected invasive fungal infection (IFI) in war wounds, Mil Med, 01 Sep 2018

  • The Joint Trauma System developed a clinical practice guideline on IFI prevention, identification and management. Aggressive and frequent surgical debridement remains the primary therapy accompanied by topical antifungal therapy

Ritter J, O'Brien S, Rivet D, Gibb I, Grimes J, Hinds S, Jessinger R, May T, Wirt M, Shackelford S, Adam O, York G, Ritchie B, Flores R, Stockinger Z. Radiology: Imaging trauma patients in a deployed setting, Mil Med, 01 Sep 2018.

  • This clinical practice guideline provides an overview of the imaging modalities available in austere settings, the equipment required, and the role that each plays in triaging and diagnosis of the acutely injured poly-trauma patients

Hall A, Sexton J, Lynch B, Boecker F, Davis EP, Sturgill E, Steinmetz M, Shackelford S, Gurney J, Stockinger Z, King B. Frostbite and immersion foot care, Mil Med, 01 Sep 2018.

  • Historically, cold injury, hypothermia, and frostbite have been severe problems for military units on the battlefield. This paper discusses the evaluation and care of these conditions.

Gordon WT, Fleming ME, Johnson AE, Gurney JM, Shackelford SA, Stockinger ZT. Pelvic fracture care, Mil Med, 01 Sep 2018.

  • The goal of this clinical practice guideline is to provide a brief review of guidelines to stabilize and treat pelvic fractures sustained in combat casualties.

Ostberg D, Loos PE, Mann-Salinas EA, Creson C, Powell D, Riesberg JC, Keenan S, Shackelford SA. Nursing interventions in prolonged field care, J Spec Oper Med, Summer 2018.

  • An overview of nursing interventions in austere environments when evacuation to a higher level of care is not immediately possible.

Loos PE, Glassman E, Doerr D, Dail R, Pamplin JC, Powell D, Riesberg JC, Keenan S, Shackelford SA. Documentation in prolonged field care, J Spec Oper Med, Spring 2018.

  • This article introduces a standardized patient record that is used to help prehospital provider guide medical treatments and communicate vital patient data, interventions and observations to the next levels of care.

Spott MA, Kurkowski CR, Burelison DR, Stockinger ZT. The DoD Trauma Registry versus the electronic health record. Mil Med 183, no. suppl_2 (2018): 8-11.

Stockinger ZT. The Joint Trauma System and the Fog of War. Mil Med, Volume 183, Issue suppl_2, 1 September 2018, 1–3.

Lloyd BA, Murray CK, Shaikh F, et al. Early infectious outcomes following addition of fluoroquinolone or aminoglycoside to post-trauma antibiotic prophylaxis in combat-related open fracture injuries. J Trauma Acute Care Surg. 2017 Nov; 83(5): 854–861.

Campbell WR, Li P, Whitman TJ, et al. Multi-drug–resistant gram-negative infections in deployment-related trauma patients. Surg Infect (Larchmt) 2017 Apr 1; 18(3): 357–367.

Lloyd BA, Murray CK, Bradley W, et al. Variation in post-injury antibiotic prophylaxis patterns over five years in a combat zone. Mil Med. 2017 Mar; 182(Suppl 1): 346–352

Godfrey BW, Martin A, Chestovich PJ, Lee GH, Ingalls NK, Saldanha V. Patients with multiple traumatic amputations: An analysis of operation enduring freedom joint theatre trauma registry data. Injury. 2017 Jan;48(1):75-79.

DeSoucy ES, Shackelford S, Dubose J, Zweben S, Rush SC, Kotwal RS, Montgomery HR, Keenan S. A novel review of 54 cases of prolonged field care. J Spec Oper Med. 2017; 17(1):121-9. PMID: 28285490.

Kotwal RS, Butler FK. Junctional hemorrhage control for tactical combat casualty care. Wilderness Environ Med. 2017; 28(Suppl 2):S33-38. PMID: 28318990.

Kotwal RS, Montgomery HR, Miles EA, Conklin CC, Hall MT, McChrystal SA. Leadership and a casualty response system for eliminating preventable death. J Trauma Acute Care Surg. 2017; 82(6 Suppl 1):S9-S15. PMID: 28333833.

Schauer SG, April MD, Naylor JF, Oliver JJ, Cunningham CW, Fisher AD, Kotwal RS. A descriptive analysis of data from the Department of Defense Joint Trauma System Prehospital Trauma Registry. US Army Med Dep J. 2017; Oct-Dec:92-97. PMID: 29214626.

Shackelford SA, del Junco DJ, Powell-Dunford N, Mazuchowski E, Howard JT, Kotwal RS, Gurney J, Butler FK, Gross K, Stockinger Z. Association of prehospital blood product transfusion during medical evacuation of combat casualties in Afghanistan with acute and 30-day survival. JAMA. 2017; 318(16):1581-1591. PMID: 29067429.

SG Schauer, MD April, E Simon, JK Maddry, et al. Prehospital interventions during mass-casualty events in Afghanistan: a case analysis. Prehospital and Disaster Medicine, Vol 32, Issue 4, August 2017 , pp. 465-468

NJ Prat, AD Meyer, NK Ingalls, et al. ROTEM significantly optimizes transfusion practices for damage control resuscitation in combat casualties. J. Trauma Acute Care Surg, Jun 6 2017.

Butler FK, Two decades of saving lives on the battlefield: tactical combat casualty care turns 20. Mil Med, Volume 182, Issue 3-4, March-April 2017, Pages e1563–e1568.

JJ Walker, ZT Stockinger, CG Chinn. Establishing a Joint Theater Trauma System During Phase Zero Operations. Mil Med, Volume 182, Issue suppl_1, March 2017, Pages 41–46

KR Gross, B Eastridge, JA Bailey, MM Knudson. Trauma system development and the Joint Trauma System. Front Line Surgery pp 761-774, 22 Jul 2017.

NA Huprikar, SD Deas, AJ Skabelund. Non-traumatic pulmonary emergencies in the deployed setting. Pulmonary in Combat Medicine. June 2017, Volume 6, Issue 2, pp 138–145

C Fredericks, JC Kubasiak, CJ Mentzer. Massive transfusion: An update for the anesthesiologist. World J Anesthesiol 2017; 6(1): 14-21

Clemens MS, Janak JC, Rizzo JA, Graybill JC, Buehner MF, Hudak SJ, Thompson CK, Chung KK. Burns to the genitalia, perineum, and buttocks increase the risk of death among U.S. service members sustaining combat-related burns in Iraq and Afghanistan, Burns, Aug 2017.

  • This study's purpose was to determine the risk of mortality associated with combat-related burns to the genitalia, perineum, and buttocks among service members injured in Iraq and Afghanistan.

Stewart IJ, Sosnov JA, Snow BD, Batou A, Howard JT, Janak JC, Bollinger M, Chung KK. Hypertension after injury among burned combat veterans: A retrospective cohort study, Burns, Mar 2017.

  • The long-term health effects of burn are poorly understood. This study evaluates the relationship between burn and the subsequent development of hypertension.

Janak JC, Orman JA, Soderdahl DW, Hudak SJ. Epidemiology of genitourinary injuries among male US service members deployed to Iraq and Afghanistan: Early findings from the Trauma Outcomes and Urogenital Health (TOUGH) Project, J Urol, Feb 2017.

  • This study reports the number, nature and severity of genitourinary injuries among male US service members deployed to Operations Iraqi Freedom and Enduring Freedom.

Howard JT, Stockinger ZT, Cap AP, Bailey JA, Gross KR. Military use of tranexamic acid in combat trauma: Does it matter? J Trauma Acute Care Surg, Oct 2017.

  • The paper provides an evaluation of the efficacy and safety of TXA use in military casualties and provide additional guidance for continued use.

Stewart IJ, Snow BD, Clemens MS, Sosnov JA, Ross JD, Howard JT, Chung KK. Hyperkalemia in combat casualties: implications for delayed evacuation, Military Medicine, Nov 2017.

  • Fixed facilities and rapid global evacuation ensured that delayed complications of trauma, such as hyperkalemia, occurred late in the evacuation chain where renal replacement therapies were available. This study sought to quantify one potential risk of delayed evacuation by assessing hyperkalemia in combat casualties.

Turner CA, Stockinger ZT, Gurney JM, Combat surgical workload in OIF/OEF: the definitive analysis, Journal of Trauma and Acute Care Surgery, 20 Apr 2017.

  • This study analyzes US military combat surgical workload in Iraq and Afghanistan to gain a more thorough understanding of surgical training gaps and personnel requirements.

Butler FK, Bennett B, Wedmore I, Tactical combat casualty care and wilderness medicine: advancing trauma care in austere environments, Wilderness and Environmental Medicine, May 2017.

  • Since most combat fatalities occur before the casualty reaches the care of a surgeon, Tactical Combat Casualty Care plays a key role in ensuring that casualties have a maximal chance of survival. This article describes the organizations leading this effort and the resulting clinical care advances.

Butler FK, Tactical combat casualty care: beginnings, Wilderness and Environmental Medicine, Jun 2017.

  • An overview of the origins of Tactical Combat Casualty Care, a set of evidence-based, best-practice prehospital trauma care guidelines customized for use on the battlefield.

Butler FK, Lessons learned in tactical combat casualty care, Journal of Trauma and Acute Care Surgery, 22 Mar 2017.

  • A discussion of lessons learned and US military's advances in trauma care achieved as a result of the conflicts in Iraq and Afghanistan and the implications of those advances for the civilian sector.

Butler FK, Bennett BL, Tactical combat casualty care: transitioning battlefield lessons learned to other austere environments, Wilderness and Environmental Medicine, 08 Mar 2017.

  • An overview of efforts to accelerate military-to-civilian translation of advances in prehospital trauma care information, training, and equipment to medical providers in other austere environments, including wilderness and mountain medicine, search and rescue, tactical law enforcement ,and emergency medical services response to terrorist-related mass casualty incidents.

Wedmore IS, Butler FK, Battlefield analgesia in tactical combat casualty care, Wilderness and Environmental Medicine, Jun 2017.

  • This paper outlines the evolution and evidence base for battlefield analgesia as recommended by Tactical Combat Casualty Care.

Butler FK, Fluid resuscitation in tactical combat casualty care: yesterday and today, Wilderness and Environmental Medicine, Jun 2017.

  • This article reviews the advances in prehospital fluid resuscitation as recommended by the original TCCC Guidelines and modified over the following 2 decades. These advances include hypotensive resuscitation, use of prehospital whole blood or blood components when feasible, and use of Hextend or selected crystalloids when logistical considerations make blood or blood component use not feasible.

Shackelford SA, Del Junco D, Powell-Dunford N, Mazuchowski E, Howard J, Kotwal R, Gurney J, Butler FK, Gross K, Stockinger ZT, Association of pre-hospital blood product transfusion during medical evacuation of combat casualties in Afghanistan with acute and 30-day survival, JAMA, 24 Oct 2017.

  • Prehospital blood product transfusion in trauma care remains controversial due to poor-quality evidence and cost. This paper examines the association of prehospital transfusion and time to initial transfusion with injury survival.

Schauer SG, Cunningham, CW, April MD, Fisher AD, Naylor JF, Kotwal RS, Oliver JJ. Descriptive analysis of data from the Department of Defense Joint Trauma System Prehospital Trauma Registry, US Army Medical Department Journal, Oct-Dec 2017, p 92.

  • This article is a descriptive analysis of data from the Joint Trauma System's (JTS) Prehospital Trauma Registry. The JTS collected trauma-associated data which comprise the PHTR are consolidated from Tactical Combat Casualty Care cards and After Action Reports.

Escolas SM, Archuleta DJ, Orman JA, Chung KK, Renz EM. Postdischarge cause-of-death analysis of combat-related burn patients. J Burn Care Res. Jan/Feb 2017.

  • This study examines the case fatality rate, causes of death, and the prevalence of suicide among 830 combat burn patients discharged from the sole burn center in the DoD, between Mar 7, 2003 and Mar 6, 2013.

van Wyck D, Loos PE, Friedline N, Stephens D, Smedick BC, McCafferty R, Rush SC, Keenan S, Powell D, Shackelford SA. Traumatic brain injury management in prolonged field care, J Spec Oper Med, Fall 2017.

  • This clinical practice guideline is meant to provide medical professionals who encounter traumatic brain injury in austere environments with evidence-based guidance.

Rapp J, Plackett TP, Crane J, Lu J, Hall A, Hardin D, Loos PE, Kelly R, Murray CK, Keenan S, Shackelford S. Acute traumatic wound management in the prolonged field care setting, J Spec Oper Med, Summer 2017.

  • This Role 1, prolonged field care guideline is intended for use after TCCC guidelines when evacuation to higher level of care is not immediately possible.

Kragh JF Jr, Aden JK Rd, Shackelford S, Moore VK 3rd, Dubick MA. Assessment of trainer skill to control groin-wound bleeding: use of junctional tourniquet models on a manikin, J Spec Oper Med, Summer 2017.

  • This purpose of this study was to assess the skills of trainers using different junctional tourniquet models to control groin bleeding in a manikin.

Plackett TP, Cherry DC, Delk G, Satterly S, Theler J, McVay D, Moore J, Shackelford SA. Clinical practice guideline adherence during Operation Inherent Resolve, J Trauma Acute Care Surg. 2017

  • A retrospective review was performed of all patients treated at 3 separate US Army Role 2 facilities during the first 10 months of Operation Inherent Resolve in Iraq. Charts were reviewed for patient demographics, clinical care, and outcomes. Charts were also reviewed for compliance with JTS CPGs and TCCC recommendations.

Mackenzie CF, Pasley J, Garofalo E, Shackelford SA, Chen H, Longinaker N, Granite G, Pugh K, Hagegeorge G, Tisherman SA. Head-camera video recordings of trauma core competency procedures can evaluate surgical resident's technical performance as well as colocated evaluators, J Trauma Acute Care Surg, 2017 Jul.

  • This study tested whether a previously validated individual procedure score for individual procedure vascular exposure and fasciotomy performance skills could discriminate training status by comparing IPS of evaluators collocated with surgeons to blind video evaluations.

Holzmacher J, Sarani B, Puche A, Granite G, Shalin V, Pugh K, Teeter W, Tisherman S, Shackelford S, Mackenzie CF. Can hyper-realistic physical models of peripheral vessel exposure and fasciotomy replace cadavers for performance assessment? J Trauma Acute Care Surg, Jul 2017

  • A comparison of same surgeon performance between synthetic and cadaveric models to determine interchangeability for formative evaluation.

DeSoucy E, Shackelford S, DuBose JJ, Zweben S, Rush SC, Kotwal RS, Montgomery HR, Keenan S. Review of 54 cases of prolonged field care, J Spec Oper Med, Spring 2017.

  • A case review was conducted to define the epidemiology, environment, and operational factors that affect prolonged field care outcomes.

Mackenzie CF, Garofalo E, Puche A, Chen H, Pugh K, Shackelford SA, Tisherman S, Henry S, Bowyer MW; Retention and Assessment of Surgical Performance (RASP) Group of Investigators. Performance of vascular exposure and fasciotomy among surgical residents before and after training compared with experts, JAMA Surg, 01 Jun 2017.

  • This longitude study measures resident surgeon technical and nontechnical skills for trauma core competencies before and after training and up to 18 months later and to compare resident performance with the performance of expert traumatologists.

Yang S, Menne A, Hu P, Stansbury L, Gao C, Dorsey N, Chiu W, Shackelford SA, Mackenzie C. Acoustic sensor versus electrocardiographically derived respiratory rate in unstable trauma patients, J Clin Monit Comput, 31 Aug 2017.

  • This paper looks at how data derived from the first 15 min of respiratory rate (RR) recording after trauma center admission using a novel acoustic sensor would compare to electrocardiogram-derived RR and to end-tidal carbon dioxide-based RR from intubated patients, the "gold standard" in predicting life-saving interventions in unstable trauma patients.

Reynolds ME, Hoover C, Riesberg JC, Mazzoli RA, Colyer M, Barnes S, Calvano CJ, Karesh JW, Murray CK, Butler FK Jr, Keenan S, Shackelford S. Evaluation and treatment of ocular injuries and vision-threatening conditions in prolonged field care, J Spec Oper Med, Winter 2017.

  • This guidelines are based on standard ophthalmic practice adopted to address the austere or remote environment, when the "Shield and Ship" guidelines are interrupted by delayed evacuation.

Beltran MJ1, Becker TE, Hurley RK, Gurney JM, Hayda RA. Resuscitation and treatment of shock. J Orthop Trauma, Oct 2016.

  • Patients with orthopaedic trauma sustained in combat frequently present in hemorrhagic shock as a result of traumatic amputations, open long bone fractures with massive soft tissue injuries, and pelvic ring disruptions. The paper reviews the advances in the care of polytraumatized patients with extremity injuries and accompanying clinical care strategies.

Stewart IJ, Sosnov JA, Howard JT, Chung KK. Acute kidney injury in critically injured combat veterans: a retrospective cohort study. Am J Kidney Dis., Oct 2016.

  • This study sought to identify risk factors for acute kidney injury (AKI) after combat trauma and evaluate whether AKI is a predictor of mortality.

Powell-Dunford N, Quesada JF, Gross KR, Shackelford SA. Army Air Ambulance Blood Product Program in the combat zone and challenges to best practices, Aerosp Med Hum Perform, Aug 2016.

  • Authors identify challenges and best practices in the development of an austere air ambulance transfusion program.

Kotwal RS, Howard JT, Orman JA, Tarpey BW, Bailey JA, Champion HR, Mabry RL, Holcomb JB, Gross KR. The effect of a Golden Hour Policy on the morbidity and mortality of combat casualties, JAMA Surg, Jan 2016.

  • Authors compare morbidity and mortality outcomes for casualties before versus after the mandate and for those who underwent prehospital helicopter transport in 60 minutes or less versus more than 60 minutes.

Le TD, Orman JA, Stockinger ZT, Spott MA, West SA, Mann-Salinas EA, Chung KK, Gross KR. The Military Injury Severity Score (mISS): A better predictor of combat mortality than Injury Severity Score (ISS), J Trauma Acute Care Surg, Jul 2016.

  • This study examines the discrepancies between military and civilian injury severity scoring systems using anatomic injury scales (mAIS vs. AIS) and injury scores (mISS vs. ISS) and determine whether the mISS is a superior injury severity scoring system for defining injury severity to compare treatment effects and injury outcomes (e.g., mortality) for combat trauma research and to inform trauma care process improvement.

Kragh JF, Lunati MP, Kharod CU, Cunningham CW, Bailey JA, Stockinger ZT, Cap AP, Chen J, Aden JK, Cancio LC. Assessment of groin application of junctional tourniquets in a manikin model, Prehosp Disaster Med, Aug 2016.

  • To aid in preparation of military medic trainers for a possible new curriculum in teaching junctional tourniquet use, the investigators studied the time to control hemorrhage and blood volume lost in order to provide evidence for ease of use.

Nnamani NS, Janak JC, Hudak SJ, Rivera JC, Lewis EA, Soderdahl DW, Orman JA. Genitourinary injuries and extremity amputation in Operations Enduring Freedom and Iraqi Freedom: Early findings from the Trauma Outcomes and Urogenital Health (TOUGH) project, J Trauma Acute Care Surg, Nov 2016.

  • This study describes extremity amputations associated with combat deployment–related genitourinary injuries in male US Operations Enduring Freedom and Iraqi Freedom service members who survived these injuries.

Rivera JC, Greer RM, Spott MA, Johnson AE. The Military Orthopaedic Trauma Registry: the potential of a specialty specific process improvement tool, J Trauma Acute Care Surg, Suppl 2 Proceedings of the 2015 Military Health System Research Symposium, Nov 2016.

  • A quality assurance survey of Military Orthopaedic Trauma Registry (MOTR) entrants aims to determine if a simple MOTR data pull could provide robust orthopaedic-specific information toward the question of causes for late amputation. Periodic quality assurance checks optimize the registry data for future quality improvement efforts.

Gerhardt RT, Reeves PT, Kotwal RS, Mabry RL, Robinson JB, Butler F, Analysis of prehospital documentation of injury-related pain assessment and analgesic administration on the contemporary battlefield, Prehospital Emergency Care Journal, 04 Jan 2016.

  • Retrospective cohort study of battlefield prehospital and hospital casualty data were abstracted by the DoD Trauma Registry from available records from 1 Sep 2007 through 30 Jun 2011. The primary focus of analysis of US combat casualty data is prehospital pain assessment, analgesic administration and documentation.

Rivera JC, Greer RM, Wenke JC, Ficke JR, Johnson AW. Military Orthopaedic Trauma Registry: Quality data now available, Journal of Surgical Orthopaedic Advances, Summer 2016.

  • As a quality improvement process, this study examined Military Orthopaedic Trauma Registry data for 20 female amputees compared with DoD Trauma Registry data

Haut ER, Mann NC, Kotwal RS, Military trauma care's learning health system: the importance of data driven decision making (Report). Commissioned by National Academies of Sciences, Engineering, and Medicine Committee on Military Trauma Care's Learning Health System and Its Translation to the Civilian Sector, 2016.

  • The report was commissioned to better understand the processes by which trauma data are collected, analyzed, and applied to guide decision making at the system and patient levels in both the military and civilian sectors.

Janak JC, Alamgir AH, Perez A, Orman JA. US military service and the prevalence of metabolic syndrome: findings from a cross-sectional analysis of the Cooper Center Longitudinal Study, 1979–2013, Preventive Medicine, Dec 2016.

  • US military service confers both health benefits and risks potentially associated with a clustering of cardiovascular risk factors called metabolic syndrome. However, the association between prior military service and metabolic syndrome has not sufficiently been examined. The purpose of the study was to compare the prevalence of metabolic syndrome by prior military service status.

Howard JT, Janak JC, Hinojosa-Laborde C, Convertino VA. Specificity of compensatory reserve and tissue oxygenation as early predictors of tolerance to progressive reductions in central blood volume, Shock, Sep 2016.

  • This experiment conducted a head-to-head comparison of technologies during controlled simulated hemorrhage in humans to test the hypothesis that measurement of the compensatory reserve would provide greater sensitivity and/or specificity to predict the onset of hemodynamic decompensation compared with SmO2.

Zhu H, Fox EE, Baraniuk S, Holcomb JB, Wade CE, Del Junco DJ, Tilley BC; PROPPR Study Group. Assessing protocol adherence in a clinical trial with ordered treatment regimens: Quantifying the pragmatic, randomized optimal platelet and plasma ratios (PROPPR) trial experience, Injury, Oct 2016.

  • Medication dispensing errors are common in clinical trials, and have a significant impact on the quality and validity of a trial. This paper focuses on errors in trials where the intervention includes multiple therapies that must be given in a pre-specified order that varies across treatment arms and varies in duration.

Zielinski MD, Wilson GA, Johnson PM, Polites SF, Jenkins DH, Harmsen WS, Holcomb JB, Wade CE, Del Junco DJ, Fox EE, Stubbs JR. Ideal hemoglobin transfusion target for resuscitation of massive-transfusion patients, Surgery, Dec 2016.

  • Over transfusion of packed red blood cells is known to increase the risk of death in stable patients. This study aimed to define the ideal hemoglobin range 24 hours after anatomic hemostasis associated with the lowest mortality.

Choi S, Rahbar MH, Ning J, Del Junco DJ, Rahbar E, Hong C, Piao J, Fox EE, Holcomb JB. Recurrent event frailty models reduced time-varying and other biases in evaluating transfusion protocols for traumatic hemorrhage, J Clin Epidemiol, Sep 2016.

  • The study objectives were to (1) accurately describe when red blood cells (RBCs), plasma, and platelets were infused and (2) assess the effect of transfused blood product ratios on in-hospital mortality. Using the proposed random-effect model, authors jointly assess recurrence intensities for RBCs and plasma (or platelet) transfusions and also include hazard rate analysis to evaluate the effects of multiple blood transfusions on early trauma mortality.

Ning J, Rahbar MH, Choi S, Hong C, Piao J, del Junco DJ, Fox EE, Rahbar E, Holcomb JB. A joint latent class analysis for adjusting survival bias with application to a trauma transfusion study, Stat Med. 15 Jan 2016.

  • This article proposes to use a latent class model to obtain a more accurate and complete metric in the presence of early death.

Mann-Salinas EA, Le TD, Shackelford SA, Bailey JA, Stockinger ZT, Spott MA, Wirt MD, Rickard R, Lane IB, Hodgetts T, Cardin S, Remick KN, Gross KR. Evaluation of role 2 (R2) medical resources in the Afghanistan combat theater: Initial review of the joint trauma system R2 registry, J Trauma Acute Care Surg, Nov 2016.

  • The purpose of this project was to undertake a preliminary review of the R2 registry to understand combat trauma epidemiology and related interventions at these facilities to guide training and optimal use of forward surgical capability in the future.

Remick KN, Shackelford SA, Oh JS, Seery JM, Grabo D, Chovanes J, Gross KR, Nessen SC, Tai NR, Rickard RF1, Elster E, Schwab CW. Surgeon preparedness for mass casualty events: Adapting essential military surgical lessons for the home front, Am J Disaster Med, Spring 2016.

  • This paper describes the unique lessons learned from combat surgery over the course of the wars in Afghanistan and Iraq and adapt these lessons to enhance civilian surgical readiness for a mass casualty event on the home front.

Gerhardt RT, Glassberg E, Holcomb JB, Mabry RL, Schreiber MB, Spinella PC. Tactical study of care originating in the prehospital environment (tacscope): acute traumatic coagulopathy on the contemporary battlefield, Shock, Sep 2016.

  • Authors analyzed US casualty records from the DoD Trauma Registry, using International Normalized Ratio of 1.5 for onset of acute traumatic coagulopathy.

Butler FK, Blackbourne LH, Gross K. The Combat Medic Aid Bag: 2025. CoTCCC Top 10 Recommended Battlefield Trauma Care Research, Development, and Evaluation Priorities for 2015. J Spec Oper Med. Winter 2015.

  • This article provides the collective judgment of the Committee of Tactical Combat Casualty Care about the highest priorities for research, development, technology and equipment that relate to battlefield trauma care.

Onifer DJ, Butler FK, Gross KR, Otten EJ, Patton R, Russell RJ, Stockinger Z, Burrell E. Replacement of Promethazine With Ondansetron for Treatment of Opioid- and Trauma-Related Nausea and Vomiting in Tactical Combat Casualty Care. J Spec Oper Med. Summer 2015

  • A discussion of the recommendation of removing promethazine from the Tactical Combat Casualty Care Guidelines and replacing it with ondansetron.

Shackelford SA, Fowler M, Schultz K, Summers A, Galvagno SM, Gross KR, Mabry RL, Bailey JA, Kotwal RS, Butler FK. Prehospital pain medication use by U.S. Forces in Afghanistan, Mil Med, Mar 2015.

  • A report of the results of a process improvement initiative to examine the current use and safety of prehospital pain medications by US Forces in Afghanistan

Sauer SW, Robinson JB, Smith MP, Gross KR, Kotwal RS, Mabry RL, Butler FK, Stockinger ZT, Bailey JA, Mavity ME, Gillies DA 2nd. Saving Lives on the Battlefield (Part II) - One year later a Joint Theater Trauma System and Joint Trauma System review of prehospital trauma care in combined joint operations area? Afghanistan (CJOA-A) Final Report, 30 May 2014. J Spec Oper Med. Summer 2015.

  • This report on prehospital trauma in the Combined Joint Operations Area-Afghanistan is a follow-on to the one previously conducted in Nov 2012 and published in Jan 2013.

Janak J, Hudak S, Soderdahl D, Oman J, Pottol K, Dean W. MP27-05 Severe war-related genitourinary injuries among male service members in OEF and OIF, The Journal of Urology, Apr 2015.

  • This study describes the epidemiology of severe war-related genitourinary injuries in this population.

Butler FK, Smith DJ, Carmona RH. Implementing and preserving the advances in combat casualty care from Iraq and Afghanistan throughout the US military, J Trauma Acute Care Surg, Aug 2015.

  • The US Military needs to ensure that casualty care advances are sustained during peace intervals and that we continue to build upon our successes as we prepare for future conflicts. This article contains recommendations designed to accomplish those goals.

Drew J, Chou VB, Miller C, Borg B, Ingalls N, Shackelford SA. Clearing the cervical spine in a war zone: what other injuries matter? Mil Med, Jul 2015.

  • Retrospective review was conducted of patients entered into DoD Trauma Registry Jan 2008 to Aug 2013, identifying blunt trauma patients with cervical spine injury and Glasgow Coma Score ≥ 14

Gerhardt RT, Reeves PT, Kotwal RS, Mabry RL, Robinson JB, Butler FK. Analysis of prehospital documentation of injury-related pain assessment and analgesic administration on the contemporary battlefield, Prehosp Emerg Care, 04 Jan 2016

  • Retrospective cohort study of battlefield prehospital and hospital casualty data were abstracted by DoDTR from available records from 1 Sep 2007 - 30 Jun 2011

Stewart IJ, Sosnov JA, Howard JT, Orman JA, Fang R, Morrow BD, Zonies DH, Bollinger M, Tuman C, Freedman BA, Chung KK. Retrospective analysis of long-term outcomes after combat injury: a hidden cost of war, Circulation, Dec 2015.

  • The paper discusses the relation between markers of injury severity and the subsequent development of hypertension, coronary artery disease, diabetes mellitus, and chronic kidney disease.

Fang R, Markandaya M, DuBose JJ, Cancio LC, Shackelford S, Blackbourne LH. Early in-theater management of combat-related traumatic brain injury: A prospective, observational study to identify opportunities for performance improvement, J Trauma Acute Care Surg, Oct 2015.

  • This is a prospective observational study of consecutive combat-related moderate-to-severe traumatic brain injury casualties presenting to US Role 3 medical facilities.

Haider AH, Piper LC, Zogg CK, Schneider EB, Orman JA, Butler FK, Gerhardt RT, Haut ER, Mather JP, MacKenzie EJ, Schwartz DA, Geyer DW, DuBose JJ, Rasmussen TE, Blackbourne LH. Military-to-civilian translation of battlefield innovations in operative trauma care, Surgery, 23 Jul 2015

  • This study surveyed trauma medical directors at level 1-3 trauma centers across the US and gauge the extent to which battlefield innovations have shaped civilian practice in 4 key domains of trauma care.

Kontos AP, Elbin RJ, Kotwal RS, Lutz RH, Kane S, Benson PJ, Forsten RD, Collins MW. The Effects of Combat-Related Mild Traumatic Brain Injury (mTBI): Does Blast mTBI History Matter? J Trauma Acute Care Surg, Oct 2015.

  • The purposes of this study were to examine prospectively the effects of mTBI on neurocognitive performance as well as mTBI and PTS symptoms among US Army Special Operations Command personnel and to study the influence of history of blast mTBI on these effects.

Stewart IJ, Sosnov JA, Howard JT, Orman JA, Fang R, Morrow BD, Zonies DH, Bollinger M, Tuman C, Freedman BA, Chung KK, Retrospective analysis of long-term outcomes after combat injury: a hidden cost of war, Circulation, Dec 2015.

  • This study set out to determine the relation between markers of injury severity and the subsequent development of hypertension, coronary artery disease, diabetes mellitus, and chronic kidney disease.

Schauer SG, Bellamy MA, Mabry RL, Bebarta VS. A comparison of the incidence of cricothyrotomy in the deployed setting to the emergency department at a level 1 military, Mil Med, Mar 2015.

  • The aim of this study was to compare the incidence and outcome of cricothyrotomies at military's only level 1 trauma center to cricothyrotomies performed in the military settings of Iraq and Afghanistan by physicians and physician assistants.
JTS: Development, Conceptual Framework, and Optimal Elements cover
JTS: Development, Conceptual Framework,
and Optimal Elements

An in-depth look into the JTS's functions and services in the arena of military and civilian treatment of trauma.
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Combat Trauma Lessons Learned from
Military Operations of 2001-2013

Theater Trauma Lessons Learned report summarizing lessons learned from the conflicts in Iraq and Afghanistan.

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Last Modified Date: 11/15/2019