Publications (10)7.88 Total impact
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Article: Short-Term Physical and Mental Health Outcomes for Combat Amputee and Nonamputee Extremity Injury Patients.
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ABSTRACT: OBJECTIVES: The present study: (1) reports the early physical health complications, mental health outcomes, and outpatient health care utilization of patients with serious extremity injuries sustained during the Iraq or Afghanistan wars and (2) compares clinical outcomes between amputee and nonamputee extremity injury groups. METHOD: This was a retrospective review of clinical records in military health databases for patients injured in the Iraq and Afghanistan wars. Health outcomes of amputee (n = 382, injured 2001-2005) and nonamputee patients (n = 274, injured 2001-2007) with serious extremity injuries (abbreviated injury score ≥ 3) were followed up to 24 months post injury. This study was performed at Naval Health Research Center, San Diego. RESULTS: Amputee and nonamputee groups had similar injury severity scores. Amputees had nearly double the risk of certain adverse complications (infections, anemia, septicemia, and thromboembolic disease), but other complications (osteomyelitis and nonhealing wound) were similar between the 2 groups. Amputees had significantly greater odds of certain mental health disorders including mood, sleep, pain, and postconcussion syndrome. However, amputees had significantly reduced odds of posttraumatic stress disorder compared with nonamputees. Amputees used various outpatient clinics significantly more than nonamputees. CONCLUSIONS: Patients with serious combat extremity injuries showed high rates of adverse health outcomes in the short term. Amputees had higher rates of many but not all clinically important physical and mental health outcomes compared to nonamputees. These results are important for military orthopaedic surgeons and allied providers who care for and counsel these patients and clinicians and researchers who seek to understand and improve health outcomes in patients with extremity war injuries.Journal of orthopaedic trauma 04/2012; · 1.78 Impact Factor -
Article: Heterotopic ossification in combat amputees from Afghanistan and Iraq wars: five case histories and results from a small series of patients.
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ABSTRACT: Heterotopic ossification (HO) is excess bone growth in soft tissues that frequently occurs in the residual limbs of combat amputees injured in Operation Iraqi Freedom and Operation Enduring Freedom, or Iraq and Afghanistan wars, respectively. HO can interfere with prosthetic use and walking and delay patient rehabilitation. This article describes symptomatic and/or radiographic evidence of HO in a patient series of combat amputees rehabilitating at a military amputee care clinic (27 patients/33 limbs). We conducted a retrospective review of patient records and physician interviews to document evidence of HO symptoms in these limbs (e.g., pain during prosthetic use, skin breakdown). Results showed HO-related symptoms in 10 of the 33 residual limbs. Radiographs were available for 25 of the 33 limbs, and a physician identified at least moderate HO in 15 of the radiographs. However, 5 of the 15 patients who showed at least moderate radiographic HO did not report adverse symptoms. Five individual patient histories described HO onset, symptoms, treatments, and outcomes. These case histories illustrated how HO location relative to pressure-sensitive/pressure-tolerant areas of the residual limb may determine whether patients experienced symptoms. These histories revealed the uncommon but novel finding of potential benefits of HO for prosthetic suspension.The Journal of Rehabilitation Research and Development 01/2011; 48(1):1-12. · 1.78 Impact Factor -
Article: The use of temporary vascular shunts in military extremity wounds: a preliminary outcome analysis with 2-year follow-up.
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ABSTRACT: The use of temporary vascular shunts (TVS)s in the management of wartime extremity vascular injuries has received an increasing amount of attention. However, the overall impact of this adjunct remains incompletely defined. The objective of this study is to characterize outcomes of those patients who suffered wartime extremity vascular injuries managed with TVSs. This is a retrospective review of the Navy and Marine Corps Combat Trauma Registry examining peripheral vascular injuries treated during the military conflicts in the Middle East. Patient demographics, injury severity score, mechanism of injury, and vessels injured were recorded. Operative reports were reviewed for use of TVSs, type of definitive repair, the need for amputation, and survival. Eighty patients were included. Forty-six (57%) had TVSs placed and 34 (43%) underwent repair at initial presentation. The mean injury severity score for the TVS group and the non-TVS groups were 15.0 +/- 5.05 and 12.9 +/- 10.18, respectively, (p = 0.229). There were a total of 13 amputations, 6 (13%) in the TVS group and 7 (21%) in the non-TVS group (p = 0.38). There was no difference in amputation rates between either group. There were no recorded mortalities in either group. Median patient follow-up was 24.5 months (range, 3-48 months). This study demonstrates the importance and utility of TVSs in the management of wartime extremity vascular injury. When used to restore perfusion to an injured extremity, there seems to be no adverse effects or overall increase in limb loss rates and therefore a useful adjunct in the surgery for limb salvage.The Journal of trauma 07/2010; 69(1):174-8. · 2.48 Impact Factor -
Article: Midterm health and personnel outcomes of recent combat amputees.
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ABSTRACT: Warfighters who sustained combat amputations in Operation Enduring Freedom or Operation Iraqi Freedom (OEF/OIF) have unique challenges during rehabilitation. This study followed their outcomes. Subjects were 382 U.S. warfighters with major limb amputations after combat injury in OEF/OIF between 2001 and 2005. Outcome measures were diagnoses, treatment codes, and personnel events captured by health and personnel databases during 24 months postinjury. Most patients had multiple complications generally within 30 days postinjury (e.g., infections, anemia), with important exceptions (e.g., heterotopic ossification). Lower limb amputees had 50% more complications than upper limb amputees. Two-thirds of patients had a mental health disorder (e.g., adjustment, post-traumatic stress disorder), with rates of major disorder categories between 18% and 25%. Over 80% of patients used physical and occupational therapy, prosthetic/orthotic services, and psychiatric care. Combat amputees had a complex set of outcomes supporting the continued need for military amputee care programs.Military medicine 03/2010; 175(3):147-54. · 0.92 Impact Factor -
Article: Marine Corps Combat Casualty Care: Determining Medical Supply Requirements for an Infantry Corpsman Bag
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ABSTRACT: Wartime experience with the current combat corpsman medical bag has shown it to be unsatisfactory for use by the infantry platoon corpsman. Part of the Marine Corps Modular Lightweight Load-Carrying Equipment (MOLLE) system, the MOLLE medical bag was designed to be a modular system that could be customized by the corpsman for specific missions. However, in the field, corpsmen say they found the bag to be too large, too heavy, and filled with supplies and equipment they never use. Experienced combat corpsmen voiced the need for a lightweight patrol medical kit containing onlWartime experience with the current combat corpsman medical bag has shown it to be unsatisfactory for use by the infantry platoon corpsman. Part of the Marine Corps Modular Lightweight Load-Carrying Equipment (MOLLE) system, the MOLLE medical bag was designed to be a modular system that could be customized by the corpsman for specific missions. However, in the field, corpsmen say they found the bag to be too large, too heavy, and filled with supplies and equipment they never use. Experienced combat corpsmen voiced the need for a lightweight patrol medical kit containing only those items necessary for immediate lifesaving treatments, such as hemorrhage control and fluid resuscitation. Naval Health Research Center was tasked by the Marine Corps Systems Command to determine the medical supply requirements for a modular corpsman s bag that could satisfy the specific wartime needs of platoon combat corpsmen.y those items necessary for immediate lifesaving treatments, such as hemorrhage control and fluid resuscitation. Naval Health Research Center was tasked by the Marine Corps Systems Command to determine the medical supply requirements for a modular corpsman s bag that could satisfy the specific wartime needs of platoon combat corpsmen.04/2006; -
Article: Wounding patterns for U.S. Marines and sailors during Operation Iraqi Freedom, major combat phase.
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ABSTRACT: This investigation examined the wounds incurred by 279 U.S. Navy-Marine personnel (97% Marines and 3% sailors) identified as wounded in action during Operation Iraqi Freedom, from March 23 through April 30, 2003. The goal was to assess the potential impact of each causative agent by comparing the differences in anatomical locations, types of injuries caused, and medical specialists needed to treat the casualties. The overall average number of diagnoses per patient was 2.2, and the overall average number of anatomical locations was 1.6. The causative agents were classified into six major categories, i.e., small arms, explosive munitions, motor vehicle accidents, falls, weaponry accidents, and other/unknown. Explosive munitions and small arms accounted for approximately three of four combat-related injuries. Upper and lower extremities accounted for approximately 70% of all injuries, a percentage consistent for battlefield injuries since World War II.Military medicine 04/2006; 171(3):246-52. · 0.92 Impact Factor -
Article: The ReSupply Validation Program (RSVP): Developing ESP Into a Tool That Validates Patient-Driven Fleet Marine Force Medical Resource Requirements
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ABSTRACT: To help the United States Marine Corps streamline its medical materiel, the Naval Health Research Center expanded the Estimating Supplies Program (ESP) into the ReSupply Validation Program (RSVP) to link medical materiel to a defined patient stream. RSVP is a simulation program that validates medical supply configurations by stochastically generating multiple iterations of a patient stream, generating the supplies necessary to treat the patients, and comparing these needs to a time-phased inventory. This report provides the context necessary to understand why a validation tool is useful for USMC; describes the methods and results in using ESP to assess item consumption rates against the current supply block configurations and in using RSVP to simulate consumption of an ESP inventory to validate the resupply block configurations; highlights the benefits of configuring supplies based on a patient stream; reviews the lessons learned from the development process; and explores possible future work.05/2003; -
Article: Estimating Supplies Program: Evaluation Report
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ABSTRACT: Naval Health Research Center developed the Estimating Supplies Program (ESP) as a decision tool for medical planners, providers, logisticians, and trainers that calculates the amount of supplies required to treat a specific patient stream and assesses inventory readiness. The purpose of this document is to explain the program methodology, algorithms, and calculations that ESP uses to estimate medical supplies and evaluate inventory readiness. Sample reports for both the estimating supplies and the inventory readiness capabilities are included to provide a concrete demonstration of ESP capabilities. To demonstrate the estimating supplies capability, two different patient streams were run through the same functional area. A comparison of the supply differences was then drawn out to show an explicit connection to the difference in the patient streams. To demonstrate the inventory readiness assessment capability, an inventory was built. Certain supply item quantities were changed and a comparison was made between the S ratings, a measure calculated to indicate the percentage of supplies on hand.12/2002; -
Article: The Air Force Global Reach Laydown (GRL): Using the Estimating Supplies Program to Validate Clinical Requirements
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Article: Risk Factors Associated with Diagnoses of Heterotopic Ossification in Recent Combat Amputees
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2002–2011
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Naval Health Research Center
San Diego, CA, USA
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