Short-Term Physical and Mental Health Outcomes for Combat Amputee and Nonamputee Extremity Injury Patients

Melcer, Ted; Walker, G. J.; Sechriest, V. Franklin; Galarneau, Michael R.; Konoske, Paula; Pyo, Jay

doi:10.1097/bot.0b013e3182517e1c

Cited by 30 publications

(29 citation statements)

References 11 publications

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“…In one study, Melcer et al found that late amputees and limb salvage patients had significantly higher rates of PTSD compared to early amputees and that late amputees had significantly higher rates of most psychological diagnoses than limb salvage patients [18]. Other studies have also shown that limb-salvage patients had significantly higher rates TBI and PTSD than amputees after sustaining lower extremity trauma but that late amputees have the highest number of total mental health conditions [15,34]. As with the presence of complications, this data seem to suggest that it is the injury, and not the treatment, that impacts an injured service member's mental reaction to his or her injury.…”

Section: Discussionmentioning

confidence: 93%

“…possible that late amputees experience the majority of their complications within the acute and sub-acute periods following late amputation evaluated by this study [15,18]. In this sense, data extracted from a relatively short interval of follow-up may overstate the impact of complications among late amputees and that the incidence of complications does, in fact, recede with time.…”

Section: Mental Health Conditionmentioning

confidence: 88%

“…Additionally, it appears that both limb salvage patients and amputees both endure adverse mental health outcomes secondary to their injuries [4,15,19,20]. What remains unknown, however, is the extent to which a late amputation decreases the likelihood of complications encountered in this population.…”

Section: Introductionmentioning

confidence: 97%

“…Recent literature has shown that both limb salvage patients and late amputees experience short and long-term extremity complications [15][16][17][18]. Additionally, it appears that both limb salvage patients and amputees both endure adverse mental health outcomes secondary to their injuries [4,15,19,20].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Late amputation may not reduce complications or improve mental health in combat-related, lower extremity limb salvage patients

Krueger

Rivera

Tennent

et al. 2015

Injury

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Section: Discussionmentioning

confidence: 93%

Section: Mental Health Conditionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Late amputation may not reduce complications or improve mental health in combat-related, lower extremity limb salvage patients

Krueger

Rivera

Tennent

et al. 2015

Injury

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“…Posttraumatic stress disorder and traumatic brain injury were also very impactful disabling conditions. While such conditions are quite common among those injured in combat, it should be recognized that such a condition is likely to hamper the rehabilitative efforts of these injured servicemembers [23]. As such, rehabilitative efforts for these servicemembers should include some aspect that deals directly with these conditions in order to maximize their outcomes.…”

Section: Figurementioning

confidence: 99%

Identifying obstacles to return to duty in severely injured combat-related servicemembers with amputation

et al. 2015

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Abstract-The capacity of servicemembers with amputation to return to duty after combat-related amputation and the associated disabilities remains largely unknown. The purpose of this study was to examine the disabling conditions and return to duty rates of servicemembers with amputation across all service branches following major limb amputations from September 2001 through July 2011. Pertinent medical information, military occupation status, return to duty designation, disabling conditions, and disability ratings for each servicemember were obtained from the Physical Evaluation Board Liaison Office (PEBLO). Across all service branches, 16 (2%) servicemembers were found fit for duty (Fit) and allowed to continue with their preinjury occupation. Another 103 (11%) were allowed to continue on Active Duty (COAD) in a less physically demanding role. More than half (554, 56%) were determined fully disabled (PEBLO rating > 75); the average disability rating was 73. COAD and Fit Army servicemembers had lower Injury Severity Scores than other servicemembers (17.4, p = 0.009 and 11.2, p < 0.001, respectively). Despite improvements in their care and rehabilitation, only 13% of all servicemembers with amputation are able to return to Active Duty and many have multiple disabling conditions that contribute to a very high level of disability.

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Glasgow Coma Scores, Early Opioids, and Posttraumatic Stress Disorder Among Combat Amputees

Melcer

Walker

Sechriest³

et al. 2014

Journal of Traumatic Stress

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A recent study found that combat amputees had a reduced prevalence of posttraumatic stress disorder (PTSD) compared with nonamputees with serious extremity injuries. We hypothesized that an extended period of impaired consciousness or early treatment with morphine could prevent consolidation of traumatic memory and the development of PTSD. To examine this hypothesis, we retrospectively reviewed 258 combat casualty records from the Iraq or Afghanistan conflicts from 2001-2008 in the Expeditionary Medical Encounter Database, including medications and Glasgow Coma Scale (GCS) scores recorded at in-theater facilities within hours of the index injury. All patients sustained amputations from injuries. Psychological diagnoses were extracted from medical records for 24 months postinjury. None of 20 patients (0%) with GCS scores of 12 or lower had PTSD compared to 20% of patients with GCS scores of 12 or greater who did have PTSD. For patients with traumatic brain injury, those treated with intravenous morphine within hours of injury had a significantly lower prevalence of PTSD (6.3%) and mood disorders (15.6%) compared to patients treated with fentanyl only (prevalence of PTSD = 41.2%, prevalence of mood disorder = 47.1%). GCS scores and morphine and fentanyl treatments were not significantly associated with adjustment, anxiety, or substance abuse disorders.

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Short-Term Physical and Mental Health Outcomes for Combat Amputee and Nonamputee Extremity Injury Patients

Abstract: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Cited by 30 publications

References 11 publications

Late amputation may not reduce complications or improve mental health in combat-related, lower extremity limb salvage patients

Late amputation may not reduce complications or improve mental health in combat-related, lower extremity limb salvage patients

Identifying obstacles to return to duty in severely injured combat-related servicemembers with amputation

Glasgow Coma Scores, Early Opioids, and Posttraumatic Stress Disorder Among Combat Amputees

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