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Manet R, Joubert C, Balanca B, Taverna XJ, Monneuse O, David JS, Dagain A. Neuro damage control: current concept and civilian applications. Neurochirurgie 2023; 69:101505. [PMID: 37806039 DOI: 10.1016/j.neuchi.2023.101505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/26/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023]
Abstract
Damage control (DC) initially referred to abbreviated (<1 h) surgical procedures to control abdominal hemorrhage in severe trauma patients, to avoid the 'bloody vicious circle' of hypothermia-coagulopathy-acidosis-hypocalcemia. Progressively, the concept was extended to pre-hospital and peri-operative surgical and non-surgical trauma care. The DC strategy can be applied either in a single severe trauma patient at risk of progression toward the bloody vicious circle or in case of limited or overwhelmed health resources (deprived environment, mass casualties, etc.). DC strategies in neurological casualties have improved over the last decade in military neurosurgeons, but remain poorly codified in civilian settings. In this comprehensive review, we summarize the current concept of neuro-DC, which includes surgical and medical care for neurological injuries as part of a DC strategy. Neuro-DC basically consists in: (i) preventing secondary brain injury; (ii) controlling intracranial bleeding; (iii) controlling intracranial pressure; (iv) limiting contamination of compound wounds; and (v) achieving secondary anatomical restoration.
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Affiliation(s)
- Romain Manet
- Service de Neurochirurgie B, Hôpital Neurologique Wertheimer, Hospices Civils de Lyon, Lyon, France.
| | - Christophe Joubert
- Service de Neurochirurgie, Hôpital d'Instruction des Armées St Anne, Toulon, France
| | - Baptiste Balanca
- Service de Neuro-Réanimation, Hôpital Neurologique Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Xavier-Jean Taverna
- Service de Réanimation Chirurgicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Olivier Monneuse
- Service de Chirurgie d'Urgence, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jean-Stéphane David
- Service de Réanimation, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Arnaud Dagain
- Service de Neurochirurgie, Hôpital d'Instruction des Armées St Anne, Toulon, France
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Hazell GA, Pearce AP, Hepper AE, Bull AMJ. Injury scoring systems for blast injuries: a narrative review. Br J Anaesth 2021; 128:e127-e134. [PMID: 34774294 DOI: 10.1016/j.bja.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/10/2021] [Accepted: 10/03/2021] [Indexed: 11/25/2022] Open
Abstract
Injury scoring systems can be used for triaging, predicting morbidity and mortality, and prognosis in mass casualty incidents. Recent conflicts and civilian incidents have highlighted the unique nature of blast injuries, exposing deficiencies in current scoring systems. Here, we classify and describe deficiencies with current systems used for blast injury. Although current scoring systems highlight survival trends for populations, there are several major limitations. The reliable prediction of mortality on an individual basis is inaccurate. Other limitations include the saturation effect (where scoring systems are unable to discriminate between high injury score individuals), the effect of the overall injury burden, lack of precision in discriminating between mechanisms of injury, and a lack of data underpinning scoring system coefficients. Other factors influence outcomes, including the level of healthcare and the delay between injury and presentation. We recommend that a new score incorporates the severity of injuries with the mechanism of blast injury. This may include refined or additional codes, severity scores, or both, being added to the Abbreviated Injury Scale for high-frequency, blast-specific injuries; weighting for body regions associated with a higher risk for death; and blast-specific trauma coefficients. Finally, the saturation effect (maximum value) should be removed, which would enable the classification of more severe constellations of injury. An early accurate assessment of blast injury may improve management of mass casualty incidents.
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Affiliation(s)
- George A Hazell
- Centre for Blast Injury Studies, Imperial College London, London, UK.
| | - A Phill Pearce
- Department of General Surgery, The Royal London Hospital, Barts NHS Trust, London, UK
| | - Alan E Hepper
- Defence Science and Technology Laboratory, Porton Down, Salisbury, UK
| | - Anthony M J Bull
- Centre for Blast Injury Studies, Imperial College London, London, UK
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Breeze J, Bowley DM, Harrisson SE, Dye J, Neal C, Bell RS, Armonda RA, Beggs AD, DuBose J, Rickard RF, Powers DB. Survival after traumatic brain injury improves with deployment of neurosurgeons: a comparison of US and UK military treatment facilities during the Iraq and Afghanistan conflicts. J Neurol Neurosurg Psychiatry 2020; 91:359-365. [PMID: 32034113 PMCID: PMC7147183 DOI: 10.1136/jnnp-2019-321723] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/14/2019] [Accepted: 01/12/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Traumatic brain injury (TBI) is the most common cause of death on the modern battlefield. In recent conflicts in Iraq and Afghanistan, the US typically deployed neurosurgeons to medical treatment facilities (MTFs), while the UK did not. Our aim was to compare the incidence, TBI and treatment in US and UK-led military MTF to ascertain if differences in deployed trauma systems affected outcomes. METHODS The US and UK Combat Trauma Registries were scrutinised for patients with HI at deployed MTFs between March 2003 and October 2011. Registry datasets were adapted to stratify TBI using the Mayo Classification System for Traumatic Brain Injury Severity. An adjusted multiple logistic regression model was performed using fatality as the binomial dependent variable and treatment in a US-MTF or UK-MTF, surgical decompression, US military casualty and surgery performed by a neurosurgeon as independent variables. RESULTS 15 031 patients arrived alive at military MTF after TBI. Presence of a neurosurgeon was associated with increased odds of survival in casualties with moderate or severe TBI (p<0.0001, OR 2.71, 95% CI 2.34 to 4.73). High injury severity (Injury Severity Scores 25-75) was significantly associated with a lower survival (OR 4×104, 95% CI 1.61×104 to 110.6×104, p<0.001); however, having a neurosurgeon present still remained significantly positively associated with survival (OR 3.25, 95% CI 2.71 to 3.91, p<0.001). CONCLUSIONS Presence of neurosurgeons increased the likelihood of survival after TBI. We therefore recommend that the UK should deploy neurosurgeons to forward military MTF whenever possible in line with their US counterparts.
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Affiliation(s)
- John Breeze
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - Douglas M Bowley
- Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
| | - Stuart E Harrisson
- Department of Neurosurgery, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, Staffordshire, UK
| | - Justin Dye
- Department of Neurosurgery, Loma Linda University, Loma Linda, California, USA
| | - Christopher Neal
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Randy S Bell
- National Capital Neurosurgery Consortium, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Rocco A Armonda
- Department of Neurosurgery, Georgetown University Medical Center, Washington, DC, USA
| | - Andrew D Beggs
- Surgical Research Laboratory, University of Birmingham, Birmingham, UK
| | - Jospeh DuBose
- Center for the Sustainment of Trauma and Readiness Skills, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
| | - Rory F Rickard
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - David Bryan Powers
- Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Zong ZW, Zhang LY, Qin H, Chen SX, Zhang L, Yang L, Li XX, Bao QW, Liu DC, He SH, Shen Y, Zhang R, Zhao YF, Zhong XZ. Expert consensus on the evaluation and diagnosis of combat injuries of the Chinese People's Liberation Army. Mil Med Res 2018; 5:6. [PMID: 29502527 PMCID: PMC5809991 DOI: 10.1186/s40779-018-0152-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/18/2018] [Indexed: 11/22/2022] Open
Abstract
The accurate assessment and diagnosis of combat injuries are the basis for triage and treatment of combat casualties. A consensus on the assessment and diagnosis of combat injuries was made and discussed at the second annual meeting of the Professional Committee on Disaster Medicine of the Chinese People's Liberation Army (PLA). In this consensus agreement, the massive hemorrhage, airway, respiration, circulation and hypothermia (MARCH) algorithm, which is a simple triage and rapid treatment and field triage score, was recommended to assess combat casualties during the first-aid stage, whereas the abbreviated scoring method for combat casualty and the MARCH algorithm were recommended to assess combat casualties in level II facilities. In level III facilities, combined measures, including a history inquiry, thorough physical examination, laboratory examination, X-ray, and ultrasound examination, were recommended for the diagnosis of combat casualties. In addition, corresponding methods were recommended for the recognition of casualties needing massive transfusions, assessment of firearm wounds, evaluation of mangled extremities, and assessment of injury severity in this consensus.
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Affiliation(s)
- Zhao-Wen Zong
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of Trauma Surgery, Daping Hospital, Army Medical University, Chongqing, China.
| | - Lian-Yang Zhang
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of Trauma Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Hao Qin
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of Trauma Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Si-Xu Chen
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of Trauma Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Lin Zhang
- Special Slinic Department of Bethune Medical Profession Sergeant School, Shijiazhuang, China
| | - Lei Yang
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of Trauma Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiao-Xue Li
- Research Institute of Disaster Medicine, General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - Quan-Wei Bao
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of Trauma Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Dao-Cheng Liu
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of Trauma Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Si-Hao He
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of Trauma Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Yue Shen
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of Trauma Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Rong Zhang
- Military Medical Training Brigade of Chinese People's Liberation Army, Hutubi, Xinjiang, Uygur Autonomous Region, China
| | - Yu-Feng Zhao
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of Trauma Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiao-Zheng Zhong
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of Trauma Surgery, Daping Hospital, Army Medical University, Chongqing, China
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