Incidence of Pulmonary Embolus in Combat Casualties With Extremity Amputations and Fractures

Gillern, Suzanne; Sheppard, Forest R.; Evans, Korboi N.; Graybill, John Christopher; Gage, Fred; Forsberg, Jonathan A.; Dunne, James R.; Tadaki, Douglas K.; Elster, Eric A.

doi:10.1097/ta.0b013e3182282574

Cited by 23 publications

(22 citation statements)

References 27 publications

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“…In the military setting, Hutchison et al, and Gillern et al, both reported bilateral lower extremity fracture as a significant risk factor for VTE development [4,8]. Hutchison identified the highest risk for VTE to be multiple-limb amputations and above-knee amputations.…”

Section: Risk Factors For the Development Of Venous Thromboembolismmentioning

confidence: 99%

“…In 2011, Gillern et al utilized retrospective data from the National Naval Medical Center (NNMC) [Bethesda, Maryland] Combat Trauma Registry to specifically evaluate casualties with wartime extremity injuries and included patients who (1) underwent at least one orthopedic procedure performed upon arrival to the USA or (2) sustained amputation before arrival [8]. In this group of 263 patients treated from March 2003-December 2007, 15 patients were diagnosed with DVT (5.7 %) and 15 with PE (5.7 %).…”

Section: Civilian Versus Combat Post-trauma Venous Thromboembolism Ratesmentioning

confidence: 99%

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Venous Thromboembolism Among Military Combat Casualties

Fang

Rodríguez

2016

Curr Trauma Rep

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Venous thromboembolism (VTE) complicates trauma no matter whether injuries occur in the civilian or combat setting. Combat casualty care is further challenged by the requirement to rapidly evacuate patients by air from the combat zone to definitive care destinations in the USA. The Joint Trauma System (JTS) is charged with ensuring optimal management of the combat injured across the global care continuum. The JTS first released guidelines for BPrevention of deep venous thrombosis^in December 2004 and regularly revises it to ensure it reflects current, best practice. This review presents a perspective on VTE impact on wartime care and the US military medical system's effort to prevent these complications.

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Section: Risk Factors For the Development Of Venous Thromboembolismmentioning

confidence: 99%

Section: Civilian Versus Combat Post-trauma Venous Thromboembolism Ratesmentioning

confidence: 99%

Venous Thromboembolism Among Military Combat Casualties

Fang

Rodríguez

2016

Curr Trauma Rep

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“…To our knowledge, the present study includes the largest retrospective analysis of combat upper limb amputation and thromboembolic disease . Nearly 20% of patients with AE amputation had DVT/PE.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Comparison of Five‐Year Health Outcomes Following Upper Limb Amputation and Serious Upper Limb Injury in the Iraq and Afghanistan Conflicts

Melcer

Walker

Sechriest³

et al. 2019

PM&R

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Background: Limited population-based research has described long-term health outcomes following combat-related upper limb amputation. Objective: To compare health outcomes following upper limb amputation with outcomes following serious upper limb injury during the first 5 years postinjury. Design: Retrospective cohort. Setting: Departments of Defense (DoD) and Veterans Affairs (VA) inpatient and outpatient health care facilities. Participants: Three-hundred eighteen U.S. Service Members. Methods: Patients sustained an above elbow (AE, n = 51) or below elbow (BE, n = 80) amputation or serious arm injury without amputation (NO AMP, n = 187) in the Iraq or Afghanistan conflicts, 2001 through 2008. Injuries were coded by trauma nurses. Outcomes came from DoD and VA health databases. Main Outcome Measurements: International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes. Results: Most patients were injured by blast weaponry causing serious to severe injuries. All groups had a high prevalence of physical and psychological health diagnoses. The prevalence for nearly all wound complications and many physical and psychological disorders decreased substantially after postinjury year 1. The prevalence of posttraumatic stress disorder, however, increased significantly from postinjury year 1 (20%) to 3 (36%). Pain and psychological disorders ranged from 69% to 90% of patients during postinjury year 1 and remained relatively high even postinjury during year 5 (37%-53%). After adjusting for covariates, the AE group had significantly higher odds for some physical and psychological diagnoses (eg, deep vein thrombosis/pulmonary embolism, cervical pain, osteoarthritis, obesity, and mood and adjustment disorders) relative to the BE or NO AMP groups. BE patients had significantly lower odds for osteomyelitis, and AE and BE patients had lower odds for fracture nonunion and joint disorders versus NO AMP. Conclusions: The results identify similarities and differences in clinical outcomes following combat-related upper limb amputation versus serious arm injury and can inform medical planning to improve rehabilitation programs and outcomes for these patients.Patients with combat-related above-elbow amputation had five times higher odds than patients with serious arm injury without amputation for developing: a. Anemia b. Deep vein thrombosis/Pulmonary Embolism c. Infection d. Arthritis

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“…Freedom and Enduring Freedom (OIF/OEF) have been characterized by wounds caused predominantly by ballistic and blast mechanisms of injury [1][2][3][4][5][6][7][8][9][10][11]. These wounds consist of massive soft tissue and orthopedic injuries secondary to the following mechanisms: damage due to pressure waves and forces exerted on bodily tissues, penetrating trauma, contamination with environmental particulates, burnrelated tissue destruction and blunt trauma from being 'thrown' by the explosion force [12].…”

Section: The Military Engagements In Operations Iraqimentioning

confidence: 99%

The Use of Urinary Bladder Matrix in the Treatment of Trauma and Combat Casualty Wound Care

et al. 2015

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Treatment of combat injuries and resulting wounds can be difficult to treat due to compromised and evolving tissue necrosis, environmental contaminants, multidrug resistant microbacterial and/or fungal infections, coupled with microvascular damage and/or hypovascularized exposed vital structures. Our group has developed surgical care algorithms with identifiable salvage techniques to achieve stable, definitive wound coverage often with the aid of certain regenerative medicine biologic scaffold materials and advanced wound care to facilitate tissue coverage and healing. This case series reports on the role of urinary bladder matrix scaffolds in the wound care and reconstruction of traumatic and combat wounds. Urinary bladder matrix was found to facilitate definitive soft tissue reconstruction by establishing a neovascularized soft tissue base acceptable for second stage wound and skin coverage options within traumatic and combat-related wounds.

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Incidence of Pulmonary Embolus in Combat Casualties With Extremity Amputations and Fractures

Cited by 23 publications

References 27 publications

Venous Thromboembolism Among Military Combat Casualties

Venous Thromboembolism Among Military Combat Casualties

A Retrospective Comparison of Five‐Year Health Outcomes Following Upper Limb Amputation and Serious Upper Limb Injury in the Iraq and Afghanistan Conflicts

The Use of Urinary Bladder Matrix in the Treatment of Trauma and Combat Casualty Wound Care

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