Biomedical subjects

James Sebesta

Publications and source records attributed to James Sebesta.

5 recordsLinked to original sources

PubMed2007

Pediatric trauma: experience of a combat support hospital in Iraq.

BACKGROUND/PURPOSE: The mission of the combat support hospital (CSH) is to evaluate and treat combatants injured during war operations. The 31st CSH in Balad and Baghdad, Iraq, during Operation Iraqi Freedom 2 also treated many injured civilians, including children. The purpose of this article is to report the experience of the 31st CSH treating pediatric trauma patients. METHODS: A retrospective review of a comprehensive patient database collected in theater was conducted. RESULTS: From January 1 to December 31, 2004, we treated 99 patients 17 years and younger. The average age of these patients was 10.6 years. Nine died of their wounds. The mean injury severity score was 11.6. Forty-one sustained gunshot wounds, 13 acquired fragment wounds (55% penetrating), and 22 were injured by improvised explosive devices (22%). Seventy-three patients required a total of 191 operations: 18 celiotomies, 8 craniotomies, 23 skeletal fixations, and 75 wound washout/debridements, among others. Predictors of mortality included admission Glasgow Coma Score less than 4 and admission pH less than 7.1. CONCLUSIONS: The primary mission of the CSH in theater remains unchanged, but its role is evolving. With this study, we can begin to understand the needs of wounded children in urban conflict and help guide training and resource allocation in the future.

Adolescent↗

PubMed2006

The use of damage-control principles for penetrating pelvic battlefield trauma.

BACKGROUND: High-velocity, penetrating pelvic injuries present one of the most difficult challenges to military trauma surgeons. The patients often present in physiologic extremis, and their injury-site patterns frequently include soft tissue, pelvic fractures, genitourinary tract, rectum, vascular structures, and intra-abdominal viscera. METHODS: A retrospective review of the 31st Combat Support Hospital damage-control laparotomy database, under an Institutional Review Board-approved protocol, revealed 28 patients with severe multisystem penetrating pelvic injuries. Up to 75 data points were queried for each patient and subjected to descriptive analysis using SPSS 11.0.4 Statistical Software Package (SPSS, Inc, Chicago, IL). RESULTS: Of 28 patients with severe penetrating pelvic injuries, 43% had extraperitoneal rectal, 43% had urologic, and 50% had major vascular injuries. On average, patients required 4 abdominal operations for treatment of all injuries. Six of 28 (21%) patients died within the first week after injury, and 36% of patients with vascular and rectal injuries died. CONCLUSIONS: Management of these injuries frequently required damage-control techniques and a staged, multidisciplinary approach to reconstruction. Combined rectal and vascular injuries were the most devastating in this type of injury complex.

Adolescent↗

PubMed2006

The impact of hypothermia on trauma care at the 31st combat support hospital.

BACKGROUND: The primary objective of this study was to review the incidence of hypothermia, and its effect on surgical management, resource utilization, and survival at the 31st Combat Support Hospital (CSH). METHODS: This study was a retrospective analysis of all combat trauma injuries treated at the 31st CSH over a 12-month period. All trauma admissions were included. Descriptive and inferential analysis were performed using SPSS 11.0 software package (SPSS Inc., Chicago, IL). RESULTS: A cohort of 2848 patients was identified; 18% were hypothermic (temperature < 36 degrees C). Hypothermia was significantly (P < .05) correlated with admission Glasgow Coma Scale (GCS), tachycardia, hypotension, lower hematocrit, and acidosis. Hypothermic patients had a significantly higher blood product and factor VIIa requirement. Hypothermia was an independent predictor of operative management of injuries, damage control laparotomy, factor VIIa use, and overall mortality (P < .05). CONCLUSION: Combat trauma patients have a high percentage of penetrating injuries with variable evacuation times. Hypothermia was a pre-hospital physiologic marker, and independent contributor to overall mortality. Prevention of hypothermia could reduce resource utilization and improve survival in the combat setting.

Adult↗

PubMed2006

Special lessons learned from Iraq.

Operation Iraqi Freedom is the largest casualty-producing conflict this nation's military has faced since Vietnam. Medical departments from the three services have done an extraordinary job reacting to the ever-changing landscape of modern warfare and the devastating injuries produced. From the revamping of prehospital care to new applications of damage-control surgery, challenges have erupted, lessons have been learned, and lives are being saved.

Blood Transfusion↗

PubMed2006

Admission physiology criteria after injury on the battlefield predict medical resource utilization and patient mortality.

BACKGROUND: Medical resources and resource allocation including operating room and blood utilization are of prime importance in the modern combat environment. We hypothesized that easily measurable admission physiologic criteria and injury site as well as injury severity calculated after diagnostic evaluation or surgical intervention, would be strongly correlated with resource utilization and in theater mortality outcomes. METHODS: We retrospectively reviewed the Joint Theater Trauma Registry for all battlefield casualties presenting to surgical component facilities during Operation Iraqi Freedom from January to July 2004. Data were collected from the composite population of 1,127 battlefield casualty patients with respect to demographics, mechanism, presentation physiology (blood pressure, heart rate, temperature), base deficit, admission hematocrit, Glasgow Coma Score (GCS), Injury Severity Score (ISS), operating room utilization, blood transfusion, and mortality. Univariate and multivariate analyses were conducted to determine the degree to which admission physiology and injury severity correlated with blood utilization, necessity for operation, and acute mortality. RESULTS: Univariate analysis demonstrated a significant (p < 0.05) association between hypothermia (T < 34 degrees C) and the subsequent requirement for operation and mortality. In addition, the outcome variable total blood product utilization was significantly correlated with base deficit (r = 0.61), admission hematocrit (r = 0.51), temperature (r = 0.47), and ISS (r = 0.54). Using multiple logistic regression techniques, blood pressure, GCS, and ISS together demonstrated a significant association (p < 0.05) with mortality (area under ROC curve = 95%). Multiple linear regression established that blood pressure, heart rate, temperature, hematocrit, and ISS had a collective significant effect (p < 0.05) on total blood product utilization explaining 67% of the variance in this outcome variable. CONCLUSION: Admission physiology and injury characteristics demonstrate a strong capacity to predict resource utilization in the contemporary battlefield environment. In the future, such predictive yield could potentially have significant implications for triage and medical logistics in the resource constrained environment of war and potentially in mass casualty and disaster incidents in the civilian trauma setting which will likely have mechanistic similarity with war related injury.

Blood Pressure↗