Abbreviations: AMA = American Medical Association, BRI = blast-related injury, CDC = Centers for Disease Control and Prevention, CNS = central nervous system, DSS = Decision Support System, FY = fiscal year, IED = improvised explosive device, JTTR
= Joint Theater Trauma Registry, MS = musculoskeletal, OIF/OEF = Operation Iraqi Freedom/Operation Enduring Freedom, PRC = Polytrauma Rehabilitation Center, R&D = Research and Development, SD = standard deviation, TPR = Tampa Polytrauma Registry, VA = Department of Veterans Affairs, VHA = Veterans Health Administration.
The Prevention component used data from the JTTR to feedback to other programs at MRMC such as the Joint Trauma Analysis and Prevention of Injury in Combat program (wwwjtapic.amedd.army.mil) for the improvement of body armor to protect the torso, pelvic, and groin regions, as well as improved eye protection.
The Leadership component advocated for and deployed a Joint Theater Trauma Director who was responsible for the in-country research team in both theaters, and for compiling, analyzing, and presenting current data from the JTTR directly to the Commander, US Central Command on a monthly basis.
(2) An additional analysis of data inclusive of all patients aged less than 19 years captured through JTTR
and PASBA reported 7,505 encounters between 2002 and 2011, representing 5.8% of all Role 3 admissions during that time.
The JTTR was implemented at Landstuhl in January 2007, and fielded in theater with the trauma nurse coordinators the following July.
The information in the JTTR also draws data abstracted from multiple electronic datasets, including the US Transportation Command Regulating and Command & Control Evacuation System, the Theater Medical Data Storage, the Composite Health Care System, and Essentris (CliniComp, International, San Diego, CA), the electronic medical record system.
Military specific data elements within the JTTR include expanded demographic data, including military branch, rank, and military occupation.
A robust performance improvement tracking system is integrated into the JTTR to allow clinical providers and trauma coordinators to concurrently track 55 user defined audit filters and 61 specific complications, as well as document primary, secondary, and tertiary case reviews.
During the period between October 2001 and July 2010, 22,800 individual US military casualties were entered in the JTTR. Due to the inherent nature of active conflict, 87% of these casualties were classified as battle injury.
A recent analysis of 3 years of trauma data from the JTTR, shown in the Figure, was significant in that the vast majority of battlefield casualties (87%) had no documentation at all of prehospital wounding mechanism, injury location, vital signs, or interventions.
* Deployed medical commanders ensure that the data is transcribed from the cards and the registries into the electronic medical records and the JTTR.
According to JTTR
data, facial burns occur in 77% of all burned service members who are evacuated from the combat theater.