Intensive Care Follow-up in UK Military Casualties: A One-Year Pilot

Abstract

Military casualties requiring intensive care were reviewed in a pilot follow-up clinic at approximately three to six months post discharge. All patients reviewed had suffered traumatic injuries in Afghanistan with a median New Injury Severity Score (NISS) of 41. Approximately 50% of casualties reviewed reported hallucinations while on ICU which were often intense and unpleasant. The predominant sedative agents used were morphine and midazolam. Occipital alopecia and pressure sores were reported as an unexpected finding in 35% of casualties. This appears to be permanent in 25% of cases and has required surgery in a small number of cases. Personality changes and anger are common and this cohort of patients can be sensitive to perceived stigmatising concerns regarding referral to psychiatric support services. Patient diaries, which were begun on intensive care in Afghanistan and continued through until discharge in the UK, were found to be very helpful. A significant proportion of clinic attendees thought the pilot clinic was helpful with a quarter of survey responders finding it very helpful. However, this was commonly based on the perception that they were helping the defence medical services improve delivery of care.

Alopecia in survivors of critical illness

“…The percentage of patients reporting alopecia was lower (17% versus 35%) than that reported by Scott et al. 4 This could be due to the higher injury severity and longer median length of stay reported in the military cohort. The military cohort was also younger and all patients male, so further research into age and sex as risk factors for alopecia may be warranted.…”

“…In the recovery phase of illness, however, alopecia can prove distressing for the patient. In the publication by Scott et al 4 in JICS, the incidence of alopecia was described in a cohort of UK military casualties. Alopecia was reported in 35% of survivors.…”

“…Alopecia was reported in 35% of survivors. 4 In response to the work by Scott et al., 4 we undertook a small pilot study to investigate the incidence and nature of patient-reported alopecia in civilian survivors of critical illness.…”

Delirium in critically ill military patients following trauma: A cohort analysis

“…Our sample was formed from patients who had survived to hospital discharge and who had attended an ICU follow-up clinic (reported as 60% attendance of invited cohort). 2 Additionally, as our patients were all survivors, we were not able to examine the relationship between delirium and mortality. Significantly increased mortality has been previously described amongst older patient groups, 18 with a smaller absolute mortality recognised across all ages, in addition to increased days of mechanical ventilation and prolonged ICU admissions, 19,20 However, the mortality rate in this patient population, once arrived in the UK, was 7.65%, a which is low relative to the mortality rate of the general ICU population.…”

“…1 A review at the DMRC ICU follow-up clinic highlighted a high incidence of psychological morbidity. 2 Whilst formal psychiatric diagnoses were beyond the scope of the clinic, the review did assess patients' recall of symptoms. One of the most notable findings was that 48% of patients recalled having significant and distressing hallucinations during their ICU admission.…”