Outcomes of Genitourinary Injury in U.S. Iraq and Afghanistan War Veterans Receiving Care from the Veterans Health Administration

Nnamani, Nina; Pugh, Mary Jo; Amuan, Megan E.; Eapen, Blessen C.; Hudak, Steven J.; Liss, Michael A.; Orman, Jean A.

doi:10.1093/milmed/usy196

Cited by 16 publications

(14 citation statements)

References 14 publications

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“…To our knowledge, only 10 studies have combined data from the DoD and VA data for the purposes of examining veterans' health. [35][36][37][38][39][40][41][42][43][44] While administrative hurdles exist in combining data from two different federal agencies, the primary issue is one of data integration. Different formats and data dictionaries are compounded by the deep institutional knowledge necessary to properly interpret the individual variables in order to ensure a basic minimum level of semantic interoperability.…”

Section: Discussionmentioning

confidence: 99%

The Enduring Health Consequences of Combat Trauma: a Legacy of Chronic Disease

et al. 2020

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Background A better understanding of the long-term health effects of combat injury is important for the management of veterans’ health in the Department of Defense (DoD) and Veterans Affairs (VA) health care systems and may have implications for primary care management of civilian trauma patients. Objective To determine the impact of traumatic injury on the subsequent development of hypertension (HTN), diabetes mellitus (DM), and coronary artery disease (CAD) after adjustment for sociodemographic, health behavior, and mental health factors. Design Retrospective cohort study of current and former US military personnel with data obtained from both the DoD and VA health care systems. Participants Combat injured (n = 8727) service members between 1 February 2002 and 14 June 2016 randomly selected from the DoD Trauma Registry matched 1:1 based on year of birth, sex, and branch of service to subjects that deployed to a combat zone but were not injured. Main Measures Traumatic injury, stratified by severity, compared with no documented injury. Diagnoses of HTN, DM, and CAD defined by International Classification of Diseases 9th or 10th Revision Clinical Modification codes. Key Results After adjustment, severe traumatic injury was significantly associated with HTN (HR 2.78, 95% CI 2.18–3.55), DM (HR 4.45, 95% CI 2.15–9.18), and CAD (HR 4.87, 95% CI 2.11–11.25), compared with no injury. Less severe injury was associated with HTN (HR 1.14, 95% CI 1.05–1.24) and CAD (HR 1.62, 95% CI 1.11–2.37). Conclusions Severe traumatic injury is associated with the subsequent development of HTN, DM, and CAD. These findings have profound implications for the primary care of injured service members in both the DoD/VA health systems and may be applicable to civilian trauma patients as well. Further exploration of pathophysiologic, health behavior, and mental health changes after trauma is warranted to guide future intervention strategies.

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Section: Discussionmentioning

confidence: 99%

The Enduring Health Consequences of Combat Trauma: a Legacy of Chronic Disease

et al. 2020

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“…[8][9][10][26][27][28][29] This includes thousands of military service members who have suffered traumatic improvised explosive device injuries to the face, neck, limbs, and genitourinary system that, in another era, would have resulted in death for many. 15,30 As a result, the DoD has invested more money and resources in VCA transplantation than any other public or private entity. Veterans were more willing to personally receive an extremity transplant than a face, penis, or uterus transplant if it was medically indicated, comparable to what has been reported elsewhere.…”

Section: Discussionmentioning

confidence: 99%

Attitudes Toward Organ, Tissue, and Vascularized Composite Allograft (VCA) Donation and Transplantation: A Survey of United States Military Veterans

et al. 2020

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Original Clinical Science-GeneralBackground. There are 20 million living US armed forces veterans; however, the organ donation attitudes of veterans have not been examined. Methods. Over a 17-month period, a convenience sample of 1517 veterans in New England completed a survey to assess attitudes about organ, tissue, and vascularized composite allograft (VCA) donation. Results. Most veterans (96%) supported the donation of organs and tissue for transplantation, and 59% were registered as an organ and tissue donor. Being younger (adjusted odds ratio [aOR]: 0.96 0.97 0.98 ; P = 0.01), female (aOR: 1.06 1.46 2.03 ; P = 0.02), non-Hispanic white (aOR: 1.30 2.07 3.30 ; P = 0.01), Hispanic (aOR: 1.28 2.43 4.61 ; P = 0.01), and having more trust that the transplant process is fair and equal (aOR: 1.19 1.40 1.65 ; P = 0.01) were predictive of donor registration. Also, most veterans were willing to donate their face (57%), hands/arms (81%), legs (81%), penis (men: 61%), and uterus (women: 76%) at time of death; donation willingness was higher for upper and lower limbs than for face or genitourinary organs (P < 0.001). Those unwilling to donate VCA organs expressed concerns about identity loss, psychological discomfort of self and others, body integrity, funeral presentation, and religious beliefs. Most (54%) felt that VCA donation should require permission of legal next-of-kin at the time of one's death, even if the decedent was a registered donor. Conclusions. There is a high level of support for organ, tissue, and VCA transplantation and donation among veterans, despite limited educational campaigns targeting this population. There is high potential among veterans to further increase donor registry enrollment and raise awareness about VCA benefits for severely injured service members.

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“…GU injury and PTSD [9]. is emphasizes the significant morbidity of bladder trauma and the need for thorough evaluation for any additional injuries in all bladder injury patients.…”

Section: Discussionmentioning

confidence: 99%

Traumatic Bladder Ruptures: A Ten-Year Review at a Level 1 Trauma Center

Barnard

Overholt

Hajiran

et al. 2019

Advances in Urology

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Bladder rupture occurs in only 1.6% of blunt abdominopelvic trauma cases. Although rare, bladder rupture can result in significant morbidity if undiagnosed or inappropriately managed. AUA Urotrauma Guidelines suggest that urethral catheter drainage is a standard of care for both extraperitoneal and intraperitoneal bladder rupture regardless of the need for surgical repair. However, no specific guidance is given regarding the length of catheterization. e present study seeks to summarize contemporary management of bladder trauma at our tertiary care center, assess the impact of length of catheterization on bladder injuries and complications, and develop a protocol for management of bladder injuries from time of injury to catheter removal. A retrospective review was performed on 34,413 blunt trauma cases to identify traumatic bladder ruptures over the past 10 years (January 2008-January 2018) at our tertiary care facility. Patient data were collected including age, gender, BMI, mechanism of injury, and type of injury. e primary treatment modality (surgical repair vs. catheter drainage only), length of catheterization, and post-injury complications were also assessed. Review of our institutional trauma database identified 44 patients with bladder trauma. Mean age was 41 years, mean BMI was 24.8 kg/m 2 , 95% were Caucasian, and 55% were female. Motor vehicle collision (MVC) was the most common mechanism, representing 45% of total injuries. Other mechanisms included falls (20%) and allterrain vehicle (ATV) accidents (13.6%). 31 patients had extraperitoneal injury, and 13 were intraperitoneal. Pelvic fractures were present in 93%, and 39% had additional solid organ injuries. Formal cystogram was performed in 59% on presentation, and mean time to cystogram was 4 hours. Gross hematuria was noted in 95% of cases. Operative management was performed for all intraperitoneal injuries and 35.5% of extraperitoneal cases. Bladder closure in operative cases was typically performed in 2 layers with absorbable suture in a running fashion. e intraperitoneal and extraperitoneal injuries managed operatively were compared, and length of catheterization (28 d vs. 22 d, p � 0.46), time from injury to normal fluorocystogram (19.8 d vs. 20.7 d, p � 0.80), and time from injury to repair (4.3 vs. 60.5 h, p � 0.23) were not statistically different between cohorts. Patients whose catheter remained in place for greater than 14 days had prolonged time to initial cystogram (26.6 d vs. 11.5 d) compared with those whose foley catheter was removed within 14 days. e complication rate was 21% for catheters left more than 14 days while patients whose catheter remained less than 14 days experienced no complications. e present study provides a 10-year retrospective review characterizing the presentation, management, and follow-up of bladder trauma patients at our level 1 trauma center. Based on our findings, we have developed an institutional protocol which now includes recommendations regarding length of catheterization after traumatic bladder rupture. B...

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Outcomes of Genitourinary Injury in U.S. Iraq and Afghanistan War Veterans Receiving Care from the Veterans Health Administration

Cited by 16 publications

References 14 publications

The Enduring Health Consequences of Combat Trauma: a Legacy of Chronic Disease

The Enduring Health Consequences of Combat Trauma: a Legacy of Chronic Disease

Attitudes Toward Organ, Tissue, and Vascularized Composite Allograft (VCA) Donation and Transplantation: A Survey of United States Military Veterans

Traumatic Bladder Ruptures: A Ten-Year Review at a Level 1 Trauma Center

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