The Golden Hour of Casualty Care: Rapid Handoff to Surgical Team is Associated With Improved Survival in War-injured US Service Members
Authors' conclusion
Rapid handoff to the surgical team within 1 hour of injury may reduce mortality by 66% in US military casualties. In the subgroup of casualties with indications for emergency surgery, rapid handoff with timely surgical intervention may reduce mortality by 60%.
Study context
- Population
- US military casualties injured in Afghanistan and Iraq, January 2007 to December 2015, alive at initial request for evacuation, maximum abbreviated injury scale ≥2, documented 30-day survival728 died within 30 days
- Participants
- 5,269 participants
- Exposure
- Handoff within 1 hour vs Delayed surgical care
- Outcome
- Mortality
- Follow-up
- 24 hours
Methodological detailspopulation-based, time-dependent covariates, sequential Cox proportional hazards regression
- Population-based
- Time-dependent covariates
- Sequential Cox proportional hazards regression
Main finding
As reported in the abstract
24-hour mortality
Handoff within 1 hour vs Delayed surgical careAdjusted hazard ratio (95% CI)P value
Handoff alive to the surgical team
0.34(0.14–0.82)
P = 0.02Timely initiation of emergency surgery, adjusted also for prior advanced resuscitative interventions
0.40(0.20–0.81)
P = 0.01Observational data: associations, not effects.
Further findings
Timing of 30-day deaths
- Deaths within 1 hour
- 68%
- Deaths within 4 hours
- 90%
In-hospital waits for surgery
- Mean wait 1.1 hours (95% CI 1.0-1.2); scarcely contributed
- P = 0.67
Original publication
The Golden Hour of Casualty Care: Rapid Handoff to Surgical Team is Associated With Improved Survival in War-injured US Service Members. Ann Surg. Published 2 January 2023. doi:10.
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