POPULATION OF INTEREST

- All patients with penetrating injury to an extremity proximal to knee/elbow with AIS ≥ 2 or diagnosis of posterior knee dislocation.
- All patients diagnosed with injury to major artery or vein (subclavian, axillary, carotid, brachial, common femoral, superficial femoral, popliteal, common iliac, external iliac, internal iliac, aorta, vena cava, portal vein, hepatic artery, mesenteric artery, renal artery).

INTENT (EXPECTED OUTCOMES)

- All patients with penetrating injury to an extremity proximal to knee/elbow with AIS ≥ 2 or diagnosis of posterior knee dislocation have injured extremity index documented.
- All patients with penetrating injury to an extremity proximal to knee/elbow with AIS ≥ 2 or diagnosis of posterior knee dislocation have neuro and vascular exam documented.
- All patients diagnosed with injury to major artery or vein undergo revascularization (shunt or repair) or ligation at the first surgical capability (or valid explanation for delay documented) prior to transfer to next level of care.
- All patients diagnosed with injury to major artery or vein who undergo reperfusion (shunt or repair) have the procedure within 4 hours of injury.
- All Patients with major vascular injury presenting with signs of hemorrhagic shock (SBP <100, HR >100) get blood products or MTP (massive transfusion protocol) activation.

PERFORMANCE / ADHERENCE METRICS

- Number and percentage of patients in the population of interest who have injured extremity index documented.
- Number and percentage of patients in the population of interest who have neuro and vascular exam documented.
- Number and percentage of patients in population of interest who undergo revascularization (shunt, repair, ligation) prior to transfer to next level of care.
- Number and percentage of patients in population of interest whose injury undergo reperfusion (shunt or repair) or ligation within 4 hours of injury.
- Number and percentage of patients in population of interest who undergo definitive Role 2 repair/reconstruction when temporary vascular shunt was feasible, and Role 3 MEDEVAC was readily available.
- Number and percentage of patients with major vascular injury presenting with signs of hemorrhagic shock (SBP <100, HR >100) get blood products or MTP (massive transfusion protocol) activation.

DATA SOURCE

- Patient Record
- Department of Defense Trauma Registry

SYSTEM REPORTING & FREQUENCY

The above constitutes the minimum criteria for PI monitoring of this CPG. System reporting will be performed annually; additional PI monitoring and system reporting may be performed as needed.

The system review and data analysis will be performed by the JTS Chief and the JTS PI team.

RESPONSIBILITIES

It is the trauma team leader’s responsibility to ensure familiarity, appropriate compliance, and PI monitoring at the local echelon with this CPG.