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Introduction of Damage Control Resuscitation Practices was associated with an increase in Injury Severity
Score of patients that died.
Level of Evidence: 3 (Evidence from non-experimental descriptive studies, such as comparative studies, correlation studies, and case-control studies).
latter half of 2005 DCR policies and DCR-based massive transfusion clinical guidelines were implemented.
As a result of this, patients treated after this point
should have been resuscitated according to the principles of DCR.
The study patients
Eligible: Soldiers (patients) treated in a US MTF who
died in hospital during Operation Iraqi Freedom
(OIF) and Operation Enduring Freedom (OEF).
Included: 2565 patients met the above eligibility criteria: 902 patients before January 2006, 1663 between
2006 and 2011.
Exclusion criteria: All patients in the registry who
survived their injury. Patients who had no recorded
vital signs (blood pressure and heart rate) on arrival
as they were assumed to be dead on arrival.
Control group: (n 902). Received uid resuscitation
prior to wide scale introduction of DCR (prior to
January 2006).
Intervention group: (n 1663). Received uid resuscitation following the wide scale implementation of
DCR (20062011).
Authors hypothesis: Independent survival benet of
DCR should also be reected by corresponding
change in the epidemiology of in-hospital trauma
deaths.
Results (Table 1)
After the introduction of DCR, the mean ISS in nonsurvivors increased from 22.5 to 26.7. The proportion
of severe injury increased from 63.5 to 79.7%
(p < 0.05). As a comparison to this apparent trend
all those on the JTTR including survivors were analyzed. This was to ensure that the apparent trend in
245
Data
Years
Patient, no.
Deaths, %
Early (024 h)
Intermediate
(17 d)
Late (>7 d)
ISS
Mean ISS
ISS > 15%
Pre-DCR
Post-DCR
20012005
902
20062001
1663
77
13
80
13
0.02
.95
13
<0.01
22.5
63.5
26.7
79.7
0.03
<0.01
246
Disclaimer
The opinions and/or assertions in this article are the personal opinions of the authors. They are not to be construed
as ocial or as reecting the views of the Army Medical
Services, British Armed Forces, Ministry of Defence or
University Hospital Birmingham Trust.
References
1. Hess JR, Holcomb JB, and Hoyt DB. Damage control
resuscitation: the need for specific blood products to
treat the coagulopathy of trauma. Transfusion 2006; 46:
685686.
2. Holcomb JB. Damage control resuscitation. J Trauma
2007; 62(6 suppl): S36S37.
Appraised by:
Charles Handford and Tomasz Torlinski, Critical Care
Unit The New Queen Elizabeth Hospital Birmingham
Mindelsohn Way Edgbaston Birmingham B15 2WB