Compartment syndrome performance improvement project is associated with increased combat casualty survival

John F. Kragh, James San Antonio, John W. Simmons, James E. MacE, Daniel J. Stinner, Christopher E. White, Raymond Fang, James K. Aden, Joseph R. Hsu, Brian J Eastridge, Donald H. Jenkins, John D. Ritchie, Mark O. Hardin, Amber E. Ritenour, Charles E. Wade, Lorne H. Blackbourne

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

BACKGROUND: In 2008, we showed that incomplete or delayed extremity fasciotomies were associated with mortality and muscle necrosis in war casualties with limb injury. Subsequently, we developed an education program focused on surgeon knowledge gaps regarding the diagnosis of compartment syndrome and prophylactic fasciotomy. The program included educational alerts, classroom training, video instruction, and a research publication. We compared casualty data before and after the program implementation to determine whether the education altered outcomes. METHODS: Similar to the previous study, a case series was made from combat casualty medical records. Casualties were US military servicemen with fasciotomies performed in Iraq, Afghanistan, or Germany between two periods (periods 1 and 2). RESULTS: In both periods, casualty demographics were similar. Most fasciotomies were performed to the lower leg and forearm. Period 1 had 336 casualties with 643 fasciotomies, whereas Period 2 had 268 casualties with 1,221 fasciotomies (1.9 vs. 4.6 fasciotomies per casualty, respectively; p < 0.0001). The mortality rate decreased in Period 2 (3%, 8 of 268 casualties) from Period 1 (8%, 26 of 336 casualties; p = 0.0125). Muscle excision and major amputation rates were similar in both periods (p > 0.05). Rates of casualties with revision fasciotomy decreased to 8% in Period 2, (22 of 268 casualties) versus 15% in Period 1 (51 of 336 casualties; p = 0.009). CONCLUSION: Combat casualty care following implementation of a fasciotomy education program was associated with improved survival, higher fasciotomy rates, and fewer revisions. Because delayed fasciotomy rates were unchanged, further effort to educate providers may be indicated. LEVEL OF EVIDENCE: Therapeutic study, level IV.

Original languageEnglish (US)
Pages (from-to)259-263
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume74
Issue number1
DOIs
StatePublished - Jan 2013
Externally publishedYes

Fingerprint

Compartment Syndromes
Education
Fasciotomy
Extremities
Afghanistan
Iraq
Forearm
Medical Records
Germany
Publications
Leg
Necrosis
Demography

Keywords

  • Health care
  • ischemia
  • quality control
  • trauma system

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Kragh, J. F., San Antonio, J., Simmons, J. W., MacE, J. E., Stinner, D. J., White, C. E., ... Blackbourne, L. H. (2013). Compartment syndrome performance improvement project is associated with increased combat casualty survival. Journal of Trauma and Acute Care Surgery, 74(1), 259-263. https://doi.org/10.1097/TA.0b013e31826fc71c

Compartment syndrome performance improvement project is associated with increased combat casualty survival. / Kragh, John F.; San Antonio, James; Simmons, John W.; MacE, James E.; Stinner, Daniel J.; White, Christopher E.; Fang, Raymond; Aden, James K.; Hsu, Joseph R.; Eastridge, Brian J; Jenkins, Donald H.; Ritchie, John D.; Hardin, Mark O.; Ritenour, Amber E.; Wade, Charles E.; Blackbourne, Lorne H.

In: Journal of Trauma and Acute Care Surgery, Vol. 74, No. 1, 01.2013, p. 259-263.

Research output: Contribution to journalArticle

Kragh, JF, San Antonio, J, Simmons, JW, MacE, JE, Stinner, DJ, White, CE, Fang, R, Aden, JK, Hsu, JR, Eastridge, BJ, Jenkins, DH, Ritchie, JD, Hardin, MO, Ritenour, AE, Wade, CE & Blackbourne, LH 2013, 'Compartment syndrome performance improvement project is associated with increased combat casualty survival', Journal of Trauma and Acute Care Surgery, vol. 74, no. 1, pp. 259-263. https://doi.org/10.1097/TA.0b013e31826fc71c
Kragh, John F. ; San Antonio, James ; Simmons, John W. ; MacE, James E. ; Stinner, Daniel J. ; White, Christopher E. ; Fang, Raymond ; Aden, James K. ; Hsu, Joseph R. ; Eastridge, Brian J ; Jenkins, Donald H. ; Ritchie, John D. ; Hardin, Mark O. ; Ritenour, Amber E. ; Wade, Charles E. ; Blackbourne, Lorne H. / Compartment syndrome performance improvement project is associated with increased combat casualty survival. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 74, No. 1. pp. 259-263.
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abstract = "BACKGROUND: In 2008, we showed that incomplete or delayed extremity fasciotomies were associated with mortality and muscle necrosis in war casualties with limb injury. Subsequently, we developed an education program focused on surgeon knowledge gaps regarding the diagnosis of compartment syndrome and prophylactic fasciotomy. The program included educational alerts, classroom training, video instruction, and a research publication. We compared casualty data before and after the program implementation to determine whether the education altered outcomes. METHODS: Similar to the previous study, a case series was made from combat casualty medical records. Casualties were US military servicemen with fasciotomies performed in Iraq, Afghanistan, or Germany between two periods (periods 1 and 2). RESULTS: In both periods, casualty demographics were similar. Most fasciotomies were performed to the lower leg and forearm. Period 1 had 336 casualties with 643 fasciotomies, whereas Period 2 had 268 casualties with 1,221 fasciotomies (1.9 vs. 4.6 fasciotomies per casualty, respectively; p < 0.0001). The mortality rate decreased in Period 2 (3{\%}, 8 of 268 casualties) from Period 1 (8{\%}, 26 of 336 casualties; p = 0.0125). Muscle excision and major amputation rates were similar in both periods (p > 0.05). Rates of casualties with revision fasciotomy decreased to 8{\%} in Period 2, (22 of 268 casualties) versus 15{\%} in Period 1 (51 of 336 casualties; p = 0.009). CONCLUSION: Combat casualty care following implementation of a fasciotomy education program was associated with improved survival, higher fasciotomy rates, and fewer revisions. Because delayed fasciotomy rates were unchanged, further effort to educate providers may be indicated. LEVEL OF EVIDENCE: Therapeutic study, level IV.",
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N2 - BACKGROUND: In 2008, we showed that incomplete or delayed extremity fasciotomies were associated with mortality and muscle necrosis in war casualties with limb injury. Subsequently, we developed an education program focused on surgeon knowledge gaps regarding the diagnosis of compartment syndrome and prophylactic fasciotomy. The program included educational alerts, classroom training, video instruction, and a research publication. We compared casualty data before and after the program implementation to determine whether the education altered outcomes. METHODS: Similar to the previous study, a case series was made from combat casualty medical records. Casualties were US military servicemen with fasciotomies performed in Iraq, Afghanistan, or Germany between two periods (periods 1 and 2). RESULTS: In both periods, casualty demographics were similar. Most fasciotomies were performed to the lower leg and forearm. Period 1 had 336 casualties with 643 fasciotomies, whereas Period 2 had 268 casualties with 1,221 fasciotomies (1.9 vs. 4.6 fasciotomies per casualty, respectively; p < 0.0001). The mortality rate decreased in Period 2 (3%, 8 of 268 casualties) from Period 1 (8%, 26 of 336 casualties; p = 0.0125). Muscle excision and major amputation rates were similar in both periods (p > 0.05). Rates of casualties with revision fasciotomy decreased to 8% in Period 2, (22 of 268 casualties) versus 15% in Period 1 (51 of 336 casualties; p = 0.009). CONCLUSION: Combat casualty care following implementation of a fasciotomy education program was associated with improved survival, higher fasciotomy rates, and fewer revisions. Because delayed fasciotomy rates were unchanged, further effort to educate providers may be indicated. LEVEL OF EVIDENCE: Therapeutic study, level IV.

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