Prolonged casualty care: Extrapolating civilian data to the military context

Nee Kofi Mould-Millman, Navneet Kaur Baidwan, Brenda Beaty, Krithika Suresh, Julia M. Dixon, Chandni Patel, Shaheem De Vries, Hendrick J. Lategan, Elmin Steyn, Janette Verster, Steven G. Schauer, Tyson E. Becker, Cord Cunningham, Sean Keenan, Ernest E. Moore, Lee A. Wallis, Adit A. Ginde, Vikhyat S. Bebarta

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND Civilian and military populations alike are increasingly faced with undesirable situations in which prehospital and definitive care times will be delayed. The Western Cape of South Africa has some similarities in capabilities, injury profiles, resource limitations, and system configuration to US military prolonged casualty care (PCC) settings. This study provides an initial description of civilians in the Western Cape who experience PCC and compares the PCC and non-PCC populations. METHODS We conducted a 6-month analysis of an ongoing, prospective, large-scale epidemiologic study of prolonged trauma care in the Western Cape (Epidemiology and Outcomes of Prolonged Trauma Care [EpiC]). We define PCC as ≥10 hours from injury to arrival at definitive care. We describe patient characteristics, critical interventions, key times, and outcomes as they may relate to military PCC and compare these using χ2 and Wilcoxon tests. We estimated the associations between PCC status and the primary and secondary outcomes using logistic regression models. RESULTS Of 995 patients, 146 experienced PCC. The PCC group, compared with non-PCC, were more critically injured (66% vs. 51%), received more critical interventions (36% vs. 29%), and had a greater proportionate mortality (5% vs. 3%), longer hospital stays (3 vs. 1 day), and higher Sequential Organ Failure Assessment scores (5 vs. 3). The odds of 7-day mortality and a Sequential Organ Failure Assessment score of ≥5 were 1.6 (odds ratio, 1.59; 95% confidence interval, 0.68-3.74) and 3.6 (odds ratio, 3.69; 95% confidence interval, 2.11-6.42) times higher, respectively, in PCC versus non-PCC patients. CONCLUSION The EpiC study enrolled critically injured patients with PCC who received resuscitative interventions. Prolonged casualty care patients had worse outcomes than non-PCC. The EpiC study will be a useful platform to provide ongoing data for PCC relevant analyses, for future PCC-focused interventional studies, and to develop PCC protocols and algorithms. Findings will be relevant to the Western Cape, South Africa, other LMICs, and military populations experiencing prolonged care. LEVEL OF EVIDENCE Therapeutic/care management; Level IV.

Original languageEnglish (US)
Pages (from-to)S78-S85
JournalJournal of Trauma and Acute Care Surgery
Volume93
Issue number2
DOIs
StatePublished - Aug 1 2022

Keywords

  • Trauma
  • morbidity
  • mortality
  • prolonged care

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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