Initial predictors associated with outcome in injured multiple traumatic limb amputations: A Kandahar-based combat hospital experience

Benfield, Rodd; Mamczak, Christiaan N.; Vo, Kim; Smith, Tricia; Osborne, Lisa A.; Sheppard, Forrest R.; Elster, Eric A.

doi:10.1016/j.injury.2012.06.030

Cited by 15 publications

(17 citation statements)

References 23 publications

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“…All patients were reported to have excellent premorbid functioning prior to ICU admission, with a median Barthel score of 20 (range [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. The median APACHE II score was 17 (IQR 13-23, range 4-43) with the median ISS in the trauma patients being 21 (IQR 10-34, range 1-59).…”

Section: Resultsmentioning

confidence: 99%

“…There was a short median ICU length of stay (LOS) of 3.0 days (IQR 1.0-6.0 days, range 0-59.0 days). In terms of functional outcome, the median 30-day Barthel score was 20 (range [7][8][9][10][11][12][13][14][15][16][17][18][19][20], reflecting excellent functional status.…”

Section: Resultsmentioning

confidence: 99%

“…These better than expected outcomes may be a result of careful patient selection in a resource-constrained system, a population that performs better than predicted, or scoring systems which may not be valid in the environment studied. [14][15][16] Despite the young age of the 30DOS cohort there was a high prevalence of co-morbidities, with 59.2% of patients having at least one co-morbidity. In contrast, the ICON audit of 10 069 ICU patients worldwide reported that 45.3% of patients in their cohort had at least one co-morbidity.…”

Section: Future Researchmentioning

confidence: 99%

“…Disease severity was determined using the APACHE II score for all patients, and in addition the Injury Severity Score (ISS) for trauma patients. [14][15][16][17] The primary study outcomes of interest were ICU mortality, ICU length of stay, 30-day mortality, and 30-day functional outcome.…”

Section: Sampling and Processmentioning

confidence: 99%

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Outcomes 30 days after ICU admission: the 30DOS study

Wise

Vasconcellos

Skinner

et al. 2017

Southern African Journal of Anaesthesia and Analgesia

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Background:The spectrum of illness and long-term outcome of critically ill patients admitted to intensive care units (ICUs) in South Africa remains largely unknown. Objectives: This study was designed to provide data on ICU outcomes and disease burden in public sector ICUs in KwaZuluNatal. The primary objective was to describe 30-day mortality of all patients admitted to participating sites. Secondary objectives included clinical demographics and spectrum of illness amongst these patients, and testing a template to demonstrate feasibility of such data collection. Methods: 30DOS was a multicentre, prospective, observational cohort study conducted over 30 days. An a priori decision was made to report study results separately for adults and paediatric patients. This article reports the results for adult patients. The complete 30-DOS study included 11 ICUs in six hospitals. All adult patients admitted to study ICUs were included. Patients were followed up telephonically by a research assistant. Data on patient demographics, preadmission functional scoring, injury severity scoring, co-morbidities, admission diagnosis/es, organ support, and outcome were collected. Results: A total of 228 adults were included. The majority of admissions (73.7%) occurred on an emergency basis, with 68.4% occurring in the postoperative period. Approximately half were for non-communicable disease (49.6%), followed by trauma (29.0%) and infectious disease (21.5%). There were a total of 59 (25.9%) deaths within the first 30 days after admission. In-ICU mortality was 19.7%. There were 12 (5.3%) in-hospital deaths following discharge and two (0.9%) out-of-hospital deaths. Thirtyday survival was known for 174 (76.3%) admissions with a 33.9% mortality rate. Conclusion: Overall in-ICU mortality was 19.7% with a large trauma burden in a young population. Thirty-day mortality was 33.9%. Information pertaining to patient demographics and spectrum of illness provided novel information to further the understanding of the demand placed on critical care resources within South Africa.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Future Researchmentioning

confidence: 99%

Section: Sampling and Processmentioning

confidence: 99%

See 2 more Smart Citations

Outcomes 30 days after ICU admission: the 30DOS study

Wise

Vasconcellos

Skinner

et al. 2017

Southern African Journal of Anaesthesia and Analgesia

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“…In 2010 and 2011, multiple limb amputations accounted for over 40 percent of all combat-related amputations, a substantial increase compared with 15 to 25 percent during previous years (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009) [1]. These patients were among the most serious cases of recent complex battle injuries in the Afghanistan conflict, including extensive blast injuries and high-level amputa tions (e.g., hip disarticulation) [2][3][4][5][6]. Importantly, these patients present substantial new challenges for rehabilita tion care providers at Department of Defense (DOD) and Department of Veterans Affairs (VA) facilities [6].…”

Section: Introductionmentioning

confidence: 99%

Rehabilitation and multiple limb amputations: A clinical report of patients injured in combat

et al. 2016

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Abstract-This clinical report describes the outpatient reha bilitation program for patients with multiple limb amputations enrolled in the Comprehensive Combat and Complex Casualty Care facility at the Naval Medical Center San Diego. Injuryspecific data for 29 of these patients wounded by blast weap onry in Afghanistan in 2010 or 2011 were captured by the Expeditionary Medical Encounter Database at the Naval Health Research Center and were reviewed for this report. Their median Injury Severity Score was 27 (N = 29; range, 11-54). Patients averaged seven moderate to serious injuries (Abbreviated Injury Scale scores 2), including multiple inju ries to lower limbs and injuries to the torso and/or upper limbs. All patients received care from numerous clinics, particularly physical therapy during the first 6 mo postinjury. Clinic use generally declined after the first 6 mo with the exception of prosthetic devices and repairs. The clinical team implemented the Mayo-Portland Adaptability Inventory, 4th Revision (MPAI-4) to assess functioning at outpatient program initiation and discharge (n = 23). At program discharge, most patients had improved scores for the MPAI-4 items assessing mobility, pain, and transportation, but not employment. Case reports described rehabilitation for two patients with triple amputa tions and illustrated multispecialty care and contrasting solu tions for limb prostheses.

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