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Potential benefits of an integrated military/civilian trauma system: experiences from two major regional conflicts

Overview of attention for article published in Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, February 2017
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Title
Potential benefits of an integrated military/civilian trauma system: experiences from two major regional conflicts
Published in
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, February 2017
DOI 10.1186/s13049-017-0360-6
Pubmed ID
Authors

Jeffry L. Kashuk, Kobi Peleg, Elon Glassberg, Adi Givon, Irina Radomislensky, Yoram Kluger

Abstract

Although differences of opinion and controversies may arise, lessons learned from military conflicts often translate into improvements in triage, resuscitation strategies, and surgical technique. Our fully integrated national trauma system, providing care for both military and civilian casualties, necessitates close cooperation between all aspects of both sectors. We theorized that lessons learned from two regional conflicts over 8 years, with resultant improved triage, reduced hospital length of stay, and sustained low mortality would aid performance improvement and provide evidence of overall trauma system maturation. We performed an 8 year, retrospective analysis of the Israeli National Trauma Registry prospective data base for all casualties presenting to level 1 and 2 trauma centers nationwide during an earlier conflict (W1) (7/12/06-8/14/06) and sought to compare results to those of a more recent war(W2), (7/08/14-08/26/14), as well as to compare our results to non-war civilian morbidity and mortality during the same time frame. Of particular interest were: casualty distributions, injuries/ISS, patterns of evacuation/triage, hospital length of stay, and mortality. Data on 919 war casualties was available for evaluation. Of 490 evacuated during W1, 341 (70%) were transferred to Level 1 centers, compared with 307 (72%) from the 429 casualties in W2. In W2, significantly more severe injuries (ISS ≥16) were evacuated directly to level 1 centers (42, 76% vs. 20, 43% respectively; p = 0.0007). W2 vs. W1 saw a significant increase in evacuations using helicopter (219,51% vs. 180,37%; p < 0.0001) and increase in ISS ≥16: (66; 15.5% vs. 55; 11%, p = 0.057). In W2 vs. W1, less late inter-hospital transfers occurred: (48, 11% vs. 149, 30%, p < 0.0001); and there was a reduction in admission ≥ 7 days (90,22%vs 154,32%, p = 0.0009). These results persisted in logistic regression analyses, when controlling for ISS..Mortality was not significantly changed either overall or for injures with ISS ≥ 16: (1.2%in W1 vs. 1.9% in W2, p = 0.59, 10.9% in W1 vs. 10.6% in W2, p = 1.0, respectively). When compared to civilian related, (non-war) mortality during the same 8 year time frame, overall mortality was unchanged (1.6% vs. 1.8%, p = 0.38), although there was a noteworthy significant decrease in mortality over time for ISS ≥ 16: 12.1 vs. 9.4 (p = 0.012), and a concomitant reduction in late inter-hospital transfers (9.8 vs. 7.5, p < 0.0001). Despite more severe injuries in the most recent regional conflict, there was increased direct triage via helicopter to level 1 centers, reduced inter-hospital transfers, reduced hospital length of stay, and persistent low mortality. Although further assessment is required, these data suggest that via ongoing cooperation in a culture of improved preparedness, an integrated military/civilian national trauma network has also positively impacted civilian results via reduced mortality in ISS ≥ 16 and reduced late inter-hospital transfers. These findings support continued maturation of the system as a whole.

Twitter Demographics

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Mendeley readers

The data shown below were compiled from readership statistics for 18 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 18 100%

Demographic breakdown

Readers by professional status Count As %
Student > Bachelor 5 28%
Student > Ph. D. Student 4 22%
Researcher 4 22%
Student > Master 3 17%
Other 1 6%
Other 1 6%
Readers by discipline Count As %
Medicine and Dentistry 11 61%
Nursing and Health Professions 2 11%
Business, Management and Accounting 1 6%
Unspecified 1 6%
Engineering 1 6%
Other 0 0%
Unknown 2 11%

Attention Score in Context

This research output has an Altmetric Attention Score of 2. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 21 July 2019.
All research outputs
#8,867,008
of 15,474,261 outputs
Outputs from Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
#627
of 950 outputs
Outputs of similar age
#129,386
of 261,815 outputs
Outputs of similar age from Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
#3
of 3 outputs
Altmetric has tracked 15,474,261 research outputs across all sources so far. This one is in the 41st percentile – i.e., 41% of other outputs scored the same or lower than it.
So far Altmetric has tracked 950 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 8.2. This one is in the 32nd percentile – i.e., 32% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 261,815 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 48th percentile – i.e., 48% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 3 others from the same source and published within six weeks on either side of this one.