- Combat Injury Related Infections
- Deployed Trauma System
- Hemorrhage Control on the Battlefield
- Management of Combat Injuries
- Resuscitation in the Combat Injured
- The effect of a golden hour policy on the morbidity and mortality of combat casualties.
- Kotwal RS, Howard JT, Orman JA, Tarpey BW, Bailey JA, Champion HR, Mabry RL, Holcomb JB, Gross KR.
- JAMA Surg. 2016 Jan;151(1):15-24.
Rationale for inclusion: Although only cited 8 times, this is a relatively recent paper and addressed a controversial topic of the "Golden Hour." This study presents data accrued before and after the mandate in 2009 for transport to surgical care within 60 minutes.
Citations - 53 (as of July 2017)
- Death on the battlefield (2001-2011): Implications for the future of combat casualty care.
- Eastridge BJ, Mabry RL, Seguin P, Cantrell J, Tops T, Uribe P, Mallett O, Zubko T, Oetjen-Gerdes L, Rasmussen TE, Butler FK, Kotwal RS, Holcomb JB, Wade C, Champion H, Lawnick M, Moores L, Blackbourne LH.
- J Trauma Acute Care Surg. 2012 Dec;73(6 Suppl 5):S431-7.
Rationale for inclusion: This was a large analysis of pre-medical treatment facility (MTF) deaths. This study identified that the vast majority of potentially surviveable pre-MTF deaths were due to hemorrhage and further classified the site of the lethal hemorrhage.
Citations - 581 (as of July 2017)
- Evaluation of military trauma system practices related to damage-control resuscitation.
- Palm K, Apodaca A, Spencer D, Costanzo G, Bailey J, Blackbourne LH, Spott MA, Eastridge BJ.
- J Trauma Acute Care Surg. 2012 Dec;73(6 Suppl 5):S459-64.
Rationale for inclusion: This is a pre-post analysis study on the implemenation of the damage control resusctitation guideline implementation in the joint theater trauma system. Effective implementation and adherence is of the guideline is associated with improved compliance with balanced component transfusion and decreased practice variability.
Citations - 32 (as of July 2017)
- Invasive mold infections following combat-related injuries.
- Warkentien T, Rodriguez C, Lloyd B, Wells J, Weintrob A, Dunne JR, Ganesan A, Li P, Bradley W, Gaskins LJ, Seillier-Moiseiwitsch F, Murray CK, Millar EV, Keenan B, Paolino K, Fleming M, Hospenthal DR, Wortmann GW, Landrum ML, Kortepeter MG, Tribble DR; Infectious Disease Clinical Research Program Trauma Infectious Disease Outcomes Study Group.
- Clin Infect Dis. 2012 Dec;55(11):1441-9.
Rationale for inclusion: This is the first description of the clnical risk factors associated with an aggressive combat-related fungal wound infection related to blast injury. From these clinical factors described the JTTS developed practice guidelines.
Citations - 87 (as of July 2017)
- Military application of tranexamic acid in trauma emergency resuscitation (MATTERs) study.
- Morrison JJ, Dubose JJ, Rasmussen TE, Midwinter MJ.
- Arch Surg. 2012 Feb;147(2):113-9.
Rationale for inclusion: This is the first military study on the use of TXA in conjunction with blood component-based resuscitation in combat casualties. Improved survival was seen in those patients who received TXA and was more prominent in those requiring massive transfusion.
Citations - 390 (as of July 2017)
- Eliminating preventable death on the battlefield.
- Kotwal RS, Montgomery HR, Kotwal BM, Champion HR, Butler FK Jr, Mabry RL, Cain JS, Blackbourne LH, Mechler KK, Holcomb JB.
- Arch Surg. 2011 Dec;146(12):1350-8.
Rationale for inclusion: This is the first review of command driven TCCC guidelines and a prehospital trauma registry and has resulted in unprecedented reduction in preventable combat deaths. This is now the model for combat casualty care on the battlefield.
Citations - 218 (as of July 2017)
- Early decompressive craniectomy for severe penetrating and closed head injury during wartime.
- Bell RS, Mossop CM, Dirks MS, Stephens FL, Mulligan L, Ecker R, Neal CJ, Kumar A, Tigno T, Armonda RA.
- Neurosurg Focus. 2010 May;28(5):E1.
Rationale for inclusion: This study is a large review of combat patients with head injuries who underwent decompressive craniectomy for severe TBI in theater. Craniectomy was employed for those with worse initial presentations and was noted to be associated with improved outcomes over time.
Citations - 80 (as of July 2017)
- Military traumatic brain and spinal column injury: a 5-year study of the impact blast and other military grade weaponry on the central nervous system.
- Bell RS, Vo AH, Neal CJ, Tigno J, Roberts R, Mossop C, Dunne JR, Armonda RA.
- J Trauma. 2009 Apr;66(4 Suppl):S104-11.
Rationale for inclusion: This is a large retrospective review of combat injured patients evacuated to a military Role V hospital for neurosurgical evaluation. This study details the epidemiology of combat related neurologic injury in the recent wars in Iraq and Afghanistan.
Citations - 148 (as of July 2017)
- An analysis of in-hospital deaths at a modern combat support hospital.
- Martin M, Oh J, Currier H, Tai N, Beekley A, Eckert M, Holcomb J.
- J Trauma. 2009 Apr;66(4 Suppl):S51-60; discussion S60-1.
Rationale for inclusion: This review of a CSH experience for potentially preventable deaths identified areas for improvement to include delays in prehospital care and in hospital hemorrhage control.
Citations - 92 (as of July 2017)
- Warm fresh whole blood is independently associated with improved survival for patients with combat-related traumatic injuries.
- Spinella PC, Perkins JG, Grathwohl KW, Beekley AC, Holcomb JB.
- J Trauma. 2009 Apr;66(4 Suppl):S69-76.
Rationale for inclusion: The military experience with fresh whole blood transfusions is largely out of necessity due to the inability to store adequate component products at forward surgical units. This retrospective study demonstrates that there is a survival advantage to WFWB transfusion in patients with hemorrhagic shock.
Citations - 230 (as of July 2017)
- An evaluation of the impact of apheresis platelets used in the setting of massively transfused trauma patients.
- Perkins JG, Cap AP, Spinella PC, Blackbourne LH, Grathwohl KW, Repine TB, Ketchum L, Waterman P, Lee RE, Beekley AC, Sebesta JA, Shorr AF, Wade CE, Holcomb JB.
- J Trauma. 2009 Apr;66(4 Suppl):S77-84; discussion S84-5.
Rationale for inclusion: This study represents a large cohort of patients treated at a combat hosptial in Iraq. Those requiring massive transfusion who received apheresed platelets in high aPLT:RBC ratio > 1:8 had improved survival.
Citations - 139 (as of July 2017)
- Survival with emergency tourniquet use to stop bleeding in major limb trauma.
- Kragh JF Jr, Walters TJ, Baer DG, Fox CJ, Wade CE, Salinas J, Holcomb JB.
- Ann Surg. 2009 Jan;249(1):1-7.
Rationale for inclusion: This is a relatively large study on the use of tourniquets in a combat hospital. The results are striking in that tourniquet use when applied early (before evidence of shock) was associated with survival in 90% versus 10% when applied in those already in shock.
Citations - 377 (as of July 2017)
- Increased mortality associated with the early coagulopathy of trauma in combat casualties.
- Niles SE, McLaughlin DF, Perkins JG, Wade CE, Li Y, Spinella PC, Holcomb JB.
- J Trauma. 2008 Jun;64(6):1459-63; discussion 1463-5.
Rationale for inclusion: In this retrospective review of combat trauma patients, acute coagulopathy was associated with mortality, similar to civilian trauma patients.
Citations - 320 (as of July 2017)
- QuikClot use in trauma for hemorrhage control: case series of 103 documented uses.
- Rhee P, Brown C, Martin M, Salim A, Plurad D, Green D, Chambers L, Demetriades D, Velmahos G, Alam H.
- J Trauma. 2008 Apr;64(4):1093-9.
Rationale for inclusion: This is unique study in that both military and civilian, surgeons and pre-hospital providers used Quickclot for hemorrhage control in over 100 cases. It was found to effective, especially in the pre-hospital setting. Only 3 cases of burns were encountered.
Citations - 181 (as of July 2017)
- Practical use of emergency tourniquets to stop bleeding in major limb trauma.
- Kragh JF Jr, Walters TJ, Baer DG, Fox CJ, Wade CE, Salinas J, Holcomb JB.
- J Trauma. 2008 Feb;64(2 Suppl):S38-49; discussion S49-50.
Rationale for inclusion: This study on tourniquet use on combat injured patients provides data that supports very minimal morbidity associated with tourniquet use including nerve palsy and no limb loss due to tourniquet use in this study.
Citations - 317 (as of July 2017)
- Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes.
- Beekley AC, Sebesta JA, Blackbourne LH, Herbert GS, Kauvar DS, Baer DG, Walters TJ, Mullenix PS, Holcomb JB; 31st Combat Support Hospital Research Group.
- J Trauma. 2008 Feb;64(2 Suppl):S28-37; discussion S37.
Rationale for inclusion: This is another study on tourniquet use at a combat hospital that further supports the use of tourniquets to aid in hemorrhage control in extremity injuries. No adverse outcomes were cited, and tourniquet use might have positively impacted potentially preventable deaths.
Citations - 285 (as of July 2017)
- The ratio of fibrinogen to red cells transfused affects survival in casualties receiving massive transfusions at an army combat support hospital.
- Stinger HK, Spinella PC, Perkins JG, Grathwohl KW, Salinas J, Martini WZ, Hess JR, Dubick MA, Simon CD, Beekley AC, Wolf SE, Wade CE, Holcomb JB.
- J Trauma. 2008 Feb;64(2 Suppl):S79-85; discussion S85.
Rationale for inclusion: In combat trauma patients who were found to need massive transfusion and also received higher ratios of fibrinogen:RBC there was increased survival.
Citations - 364 (as of July 2017)
- Joint theater trauma system implementation of burn resuscitation guidelines improves outcomes in severely burned military casualties.
- Ennis JL, Chung KK, Renz EM, Barillo DJ, Albrecht MC, Jones JA, Blackbourne LH, Cancio LC, Eastridge BJ, Flaherty SF, Dorlac WC, Kelleher KS, Wade CE, Wolf SE, Jenkins DH, Holcomb JB.
- J Trauma. 2008 Feb;64(2 Suppl):S146-51; discussion S151-2.
Rationale for inclusion: Prospectively collected data on burn casualties was compared to patients treated in theater prior to the Burn Resusciation Guidelines. This paper demonstrated the improved mortality associated with implementation of the guidelines, but more importantly it highlighted the implementation and effectiveness of the Clinical Practice Guidelines.
Citations - 113 (as of July 2017)
- Amputations in U.S. military personnel in the current conflicts in Afghanistan and Iraq.
- Stansbury LG, Lalliss SJ, Branstetter JG, Bagg MR, Holcomb JB.
- J Orthop Trauma. 2008 Jan;22(1):43-6.
Rationale for inclusion: This study from early in the Afghanistan and Iraq wars reviewed over 5000 patients with limb injuries. This is a detailed epidemiological review on the injury patters, level of amputations, and mechanism of injury.
Citations - 132 (as of July 2017)
- Tactical combat casualty care 2007: evolving concepts and battlefield experience.
- Butler FK Jr, Holcomb JB, Giebner SD, McSwain NE, Bagian J.
- Mil Med. 2007 Nov;172(11 Suppl):1-19.
Rationale for inclusion: This review describes the development and evolution of the TCCC guidelines from inception in 1996 through continuous updates organized by the Committee on TCCC.
Citations - 194 (as of July 2017)
- Risks associated with fresh whole blood and red blood cell transfusions in a combat support hospital.
- Spinella PC, Perkins JG, Grathwohl KW, Repine T, Beekley AC, Sebesta J, Jenkins D, Azarow K, Holcomb JB; 31st Combat Support Hospital Research Working Group.
- Crit Care Med. 2007 Nov;35(11):2576-81.
Rationale for inclusion: The use of WFWB transfusion, especially in combat resusciation, is known to incur a survival advantage. Concerns over safety of FWB tranfsusion exist. This study shows that the risk of infection disease transmission can be minimized for FWB transfusion in a pre-screened miiltary combat environment.
Citations - 115 (as of July 2017)
- The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital.
- Borgman MA, Spinella PC, Perkins JG, Grathwohl KW, Repine T, Beekley AC, Sebesta J, Jenkins D, Wade CE, Holcomb JB.
- J Trauma. 2007 Oct;63(4):805-13.
Rationale for inclusion: This retrospective review of combat patients requiring massive tranfusion showed that those who received high plasma to PRBC ratios had improved survival. This is clearly a landmark paper that significantly impacted both military and civilian blood resuscitation therapy and massive transfusion protocols.
Citations - 1252 (as of July 2017)
- Early predictors of massive transfusion in combat casualties.
- Schreiber MA1, Perkins J, Kiraly L, Underwood S, Wade C, Holcomb JB.
- J Am Coll Surg. 2007 Oct;205(4):541-5.
Rationale for inclusion: This is retrospective review of combat patients requiring massive transfusion. Massive transfusion in this group was associated with higher mortality, and variable present early upon admission can predict the need for massive transfusion.
Citations - 183 (as of July 2017)
- Infectious complications of open type III tibial fractures among combat casualties.
- Johnson EN, Burns TC, Hayda RA, Hospenthal DR, Murray CK.
- Clin Infect Dis. 2007 Aug 15;45(4):409-15.
Rationale for inclusion: High energy combat wounds frequently resulted in open tibial fractures. Infectious complications were common and even associated with limb amputations as described in this paper.
Citations - 205 (as of July 2017)
- An outbreak of multidrug-resistant Acinetobacter baumannii-calcoaceticus complex infection in the US military health care system associated with military operations in Iraq.
- Scott P, Deye G, Srinivasan A, Murray C, Moran K, Hulten E, Fishbain J, Craft D, Riddell S, Lindler L, Mancuso J, Milstrey E, Bautista CT, Patel J, Ewell A, Hamilton T, Gaddy C, Tenney M, Christopher G, Petersen K, Endy T, Petruccelli B.
- Clin Infect Dis. 2007 Jun 15;44(12):1577-84.
Rationale for inclusion: This study investigated an outbreak Acinetobacter at US field hospitals during recent military operations. The results of this investigation have been widely cited in the development of infection control guidelines.
Citations - 325 (as of July 2017)
- Causes of death in U.S. Special Operations Forces in the global war on terrorism: 2001-2004.
- Holcomb JB, McMullin NR, Pearse L, Caruso J, Wade CE, Oetjen-Gerdes L, Champion HR, Lawnick M, Farr W, Rodriguez S, Butler FK.
- Ann Surg. 2007 Jun;245(6):986-91.
Rationale for inclusion: This is the initial paper on modern battlefield deaths. It not only describes the mechanism of injury but also discussed the causes of potentially surviveable deaths.
Citations - 510 (as of July 2017)
- Trauma-related infections in battlefield casualties from Iraq.
- Petersen K, Riddle MS, Danko JR, Blazes DL, Hayden R, Tasker SA, Dunne JR.
- Ann Surg. 2007 May;245(5):803-11.
Rationale for inclusion: This is a retrospective review from the Iraq war. In a short period of time a relatively large number of patients with combat related infections were seen. This paper describes the characteristics of these infections as they relate to the types of war wounds.
Citations - 170 (as of July 2017)
- Characterization of extremity wounds in Operation Iraqi Freedom and Operation Enduring Freedom.
- Owens BD, Kragh JF Jr, Macaitis J, Svoboda SJ, Wenke JC.
- J Orthop Trauma. 2007 Apr;21(4):254-7.
Rationale for inclusion: Extremity wounds have been commonly reported in the most recent wars. This is an epidemiological study of a large cohort of combat injured patients with extremity injuries describing anatomic location, mechanisms of injury, and characteristics of the injuries.
Citations - 387 (as of July 2017)
- Damage control resuscitation: directly addressing the early coagulopathy of trauma.
- Holcomb JB, Jenkins D, Rhee P, Johannigman J, Mahoney P, Mehta S, Cox ED, Gehrke MJ, Beilman GJ, Schreiber M, Flaherty SF, Grathwohl KW, Spinella PC, Perkins JG, Beekley AC, McMullin NR, Park MS, Gonzalez EA, Wade CE, Dubick MA, Schwab CW, Moore FA, Champion HR, Hoyt DB, Hess JR.
- J Trauma. 2007 Feb;62(2):307-10.
Rationale for inclusion: Although this is a commentary, it represents one of the earliest and most recognized discussions of damage control resusctation.
Citations - 956 (as of July 2017)
- Trauma system development in a theater of war: experiences from Operation Iraqi Freedom and Operation Enduring Freedom.
- Eastridge BJ, Jenkins D, Flaherty S, Schiller H, Holcomb JB.
- J Trauma. 2006 Dec;61(6):1366-72; discussion 1372-3.
Rationale for inclusion: This is the first detailed description of the implementaion of the Joint Theater Trauma System. The implementation of the system helped identify multiple systems issues for the improvement of patient care including patient transfer to the appropriate level of care, the development of a trauma registry and performance improvement.
Citations - 277 (as of July 2017)
- The use of temporary vascular shunts as a damage control adjunct in the management of wartime vascular injury.
- Rasmussen TE, Clouse WD, Jenkins DH, Peck MA, Eliason JL, Smith DL.
- J Trauma. 2006 Jul;61(1):8-12; discussion 12-5.
Rationale for inclusion: This study details over 120 combat injured patients with vascular injuries treated at far forward locations. Temporary vascular shunts were used in the management of more than 50% with resultant good outcomes.
Citations - 217 (as of July 2017)
- The impact of hypothermia on trauma care at the 31st combat support hospital.
- Arthurs Z1, Cuadrado D, Beekley A, Grathwohl K, Perkins J, Rush R, Sebesta J.
- Am J Surg. 2006 May;191(5):610-4.
Rationale for inclusion: This study represented a large cohort of patients (2848) who presented to a CSH over a 12 month period. 18% were hypothermic on presentation, and hypothermia was an independent predictor of damage control laparotomy and mortality.
Citations - 107 (as of July 2017)
- Contemporary management of wartime vascular trauma.
- Fox CJ, Gillespie DL, O'Donnell SD, Rasmussen TE, Goff JM, Johnson CA, Galgon RE, Sarac TP, Rich NM.
- J Vasc Surg. 2005 Apr;41(4):638-44.
Rationale for inclusion: This paper is from early on in the Iraq and Afghanistan wars and includes over 100 combat patients with vascular injuries. Details regarding amputation rates, vascular repair in far forward surgical settings and additional operative interventions required up-range are discussed.
Citations - 224 (as of July 2017)
- Combat trauma experience with the United States Army 102nd Forward Surgical Team in Afghanistan.
- Beekley AC, Watts DM.
- Am J Surg. 2004 May;187(5):652-4.
Rationale for inclusion: This retrospective review of the FST is an account of the initial set up and experience in the forward setting and ausetere environment.
Citations - 141 (as of July 2017)
- Tourniquets for hemorrhage control on the battlefield: a 4-year accumulated experience.
- Lakstein D, Blumenfeld A, Sokolov T, Lin G, Bssorai R, Lynn M, Ben-Abraham R.
- J Trauma. 2003 May;54(5 Suppl):S221-5.
Rationale for inclusion: This study utilizes data that mostly pre-dates the US involvement in the Iraq and Afghanistan. The Israeli Defense Forces provide data supporting tourniquet use by pre-hospital medical and non-medical personnel as means of hemorrhage control in those with exsanguinating extremity wounds.
Citations - 253 (as of July 2017)
- Tactical combat casualty care in special operations.
- Butler FK Jr, Hagmann J, Butler EG.
- Mil Med. 1996 Aug;161 Suppl:3-16.
Rationale for inclusion: This paper presents the results of a study that evaluated the appropriateness of the measures used by combat medics. A new basic management protocol was proposd that organized combat casualty care into 3 phases with appropriate measures.
Citations - 334 (as of July 2017)
- Acute arterial injuries in Vietnam: 1,000 cases.
- Rich NM, Baugh JH, Hughes CW.
- J Trauma. 1970 May;10(5):359-69.
Rationale for inclusion: This is a large review with data on mechanism of injury, location of injury, management choices, morbidity and mortality by another giant in military surgery, Dr. Norm Rich.
Citations - 547 (as of July 2017)
- Battle injuries of the arteries in World War II: an analysis of 2,471 cases.
- Debakey ME, Simeone FA.
- Ann Surg. 1946 Apr;123(4):534-79.
Rationale for inclusion: As much a historical lesson than a scientific paper, Dr. DeBakey reviews over 2000 cases of vascular injuries compared from civil war through WWII. There are detailed descriptions of anatomic injuries, amputation rates, options for repair, etc.
Citations - 1094 (as of July 2017)