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Transport time after combat-related injury and patient-reported outcomes among US service members
  1. Raneem J Hawari1,2,
  2. C T McCabe1,2,
  3. A L Dougherty1,2,
  4. S L Eskridge1,2,
  5. J R Watrous1,2,
  6. J Sazon1,3 and
  7. M R Galarneau1
  1. 1Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, California, USA
  2. 2Leidos Inc, San Diego, California, USA
  3. 3Axiom, San Diego, California, USA
  1. Correspondence to Dr C T McCabe, Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, CA 92152, USA; cameron.t.mccabe.ctr{at}mail.mil

Abstract

Introduction The ‘golden hour’ is a universal paradigm that suggests trauma patients have lower morbidity and mortality when provided with medical care within 1 hour after injury. The objective of this study was to examine whether transport time from point of injury to a military treatment facility (MTF) in-theatre was associated with patient-reported outcomes, such as post-traumatic stress disorder (PTSD), depression and quality of life (QOL), among US service members with combat-related injury.

Methods Participants were injured between March 2003 and March 2016 and completed standardised assessments of PTSD, depression and QOL for theWounded Warrior Recovery Project (WWRP) between January 2013 and November 2017. Multivariable regressions were used to assess the relationship between transport time (≤1 hour or >1 hour from injury to MTF) and positive screens for PTSD and depression, and QOL, respectively.

Overall, 45.6% of participants (n=879) arrived at an MTF within 1 hour postinjury. About 8 years passed between when participants were injured on deployment and when they completed their first WWRP assessment. Approximately 48% of participants screened positive for PTSD and 51.3% for depression, with a mean QOL score of 0.513 (SD=0.150). After adjusting for covariates, transport time was not significantly associated with PTSD (OR 1.04, 95% CI 0.79 to 1.38; p=0.77), depression (OR 0.92, 95% CI 0.69 to 1.21; p=0.55) or QOL (β=0.009; p=0.38).

Conclusion Transport time was not associated with patient-reported outcomes among US service members with combat-related injury. These findings are important as we seek to understand how combat casualties may be affected by extended medical evacuation or transport times anticipated in future expeditionary operations.

  • mental health
  • epidemiology
  • accident & emergency medicine

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Footnotes

  • Contributors RJH and CTM designed the study. JRW, JS and MG acquired the data. RJH, SLE and CTM analysed the data. All authors interpreted the data. RJH, CTM and AD drafted the manuscript. SLE, JRW, JS and MG critically revised the manuscript for important intellectual content. All authors approved the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This research was supported by the US Navy Bureau of Medicine and Surgery under work unit no 60808.

  • Disclaimer I am a military service member or employee of the US Government. This work was prepared as part of my official duties. Title 17, USC §105 provides that copyright protection under this title is not available for any work of the US Government. Title 17, USC §101 defines a US Government work as work prepared by a military service member or employee of the US Government as part of that person’s official duties. Report #20-054 was supported by the US Navy Bureau of Medicine and Surgery under work unit no 60808. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the US Government. The study protocol was approved by the Naval Health Research Center Institutional Review Board in compliance with all applicable Federal regulations governing the protection of human subjects. Research data were derived from an approved Naval Health Research Center Institutional Review Board protocol, number NHRC 2009.0014.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Naval Health Research Center Institutional Review Board.

  • Data availability statement No data are available. The datasets generated and/or analysed during the current study are not publicly available due to personally identifiable information regulations, but may be made available by the corresponding author on reasonable request and approval by the Naval Health Research Center Institutional Review Board.

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