Midterm Health and Personnel Outcomes of Recent Combat Amputees

Melcer, Ted; Walker, G. J.; Galarneau, Michael R.; Belnap, Brian; Konoske, Paula

doi:10.7205/milmed-d-09-00120

Cited by 49 publications

(46 citation statements)

References 29 publications

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“…After adjusting for ISS and amputation location, servicemembers with a recorded TBI, on average, required a significantly greater number of physical therapy, occupational therapy, and combined medical and rehabilitative visits over the 2 yr follow-up period. For outpatient visits, we observed a relatively high use of outpatient physical therapy, occupational therapy, and prosthetic training services soon after the injury, which is similar to those reported by others [21,34,[42][43]. Throughout much of the 2 yr follow-up period, the mean number of occupational therapy visits remained higher for servicemembers with TBI relative to those without TBI.…”

Section: Medical and Rehabilitative Visits By Traumatic Brain Injury supporting

confidence: 76%

“…Traumatic limb loss involves many short-and longterm physical and psychosocial issues, including those related to heterotopic ossification, recurrent infection, prosthetic donning, ambulation, activities of daily living, depression, posttraumatic stress disorder, and return to duty [21,[34][35]. A consequence unique to this population is increased risk of TBI caused by blast injury from land mines, rocket-propelled grenades, bombs, artillery, and IEDs [21].…”

Section: Frequency Of Traumatic Brain Injury In Servicemembers With mentioning

confidence: 99%

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Effect of traumatic brain injury among U.S. servicemembers with amputation

Rauh¹,

Aralis²,

Melcer³

et al. 2013

JRRD

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Abstract-Servicemembers with combat-related limb loss often require substantial rehabilitative care. The prevalence of traumatic brain injury (TBI), which may impair cognitive and functional abilities, among servicemembers has increased. The primary objectives of this study were to determine the frequency of TBI among servicemembers with traumatic amputation and examine whether TBI status was associated with discharge to civilian status and medical and rehabilitative service use postamputation. U.S. servicemembers who had a combat-related amputation while deployed in Iraq or Afghanistan between 2001 and 2006 were followed for 2 yr postamputation. Data collected includes injury mechanism; postinjury complications; Injury Severity Score (ISS); and follow-up data, including military service discharge status and number of medical, physical, occupational therapy, and prosthetic-related visits. Of the 546 servicemembers with combat-related amputations, 127 (23.3%) had a TBI diagnosis. After adjusting for ISS and amputation location, those with TBI had a significantly greater mean number of medical and rehabilitative outpatient and inpatient visits combined (p < 0.01). Those with TBI were also at greater odds of developing certain postinjury complications. We recommend that providers treating servicemembers with limb loss should assess for TBI because those who sustained TBI required increased medical and rehabilitative care.

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Section: Medical and Rehabilitative Visits By Traumatic Brain Injury supporting

confidence: 76%

Section: Frequency Of Traumatic Brain Injury In Servicemembers With mentioning

confidence: 99%

Effect of traumatic brain injury among U.S. servicemembers with amputation

Rauh¹,

Aralis²,

Melcer³

et al. 2013

JRRD

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“…These descriptions are important, given the unique injury profiles of recent combat amputees [9][10][11][12] and the high frequency of HO occurring in this population [1,2,13]. Patient histories can be instructive for both civilian and military prosthetists, surgeons, and physical rehabilitation specialists.…”

Section: Introductionmentioning

confidence: 99%

Heterotopic ossification in combat amputees from Afghanistan and Iraq wars: Five case histories and results from a small series of patients

Melcer

Belnap²,

Walker³

et al. 2011

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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/pressuretolerant 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.

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“…Little is known about the long-term psychological outcomes for combat amputees. They typically discharge from military service within the first 2 yr postinjury [6,[24][25] and may receive postinjury care from military and/or Department of Veterans Affairs (VA) healthcare systems [26]. Separation from supportive military amputee care [27] presents new social, financial, and occupational challenges of long-term disability [28][29][30][31].…”

Section: Introductionmentioning

confidence: 99%

Glasgow Coma Scale scores, early opioids, and 4-year psychological outcomes among combat amputees

et al. 2014

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Abstract-Morphine and fentanyl are frequently used for analgesia after trauma, but there is debate over the advantages and disadvantages of these opioids. Among combat amputees, intravenous (IV) morphine (vs IV fentanyl) after injury was associated with reduced likelihood of posttraumatic stress disorder (PTSD). The previous results were based on military health diagnoses over 2 yr postinjury. The present study followed psychological diagnoses of patients with amputation for 4 yr using military and Department of Veterans Affairs health data. Intheater combat casualty records (n = 145) documented Glasgow Coma Scale (GCS) scores and/or morphine, fentanyl, or no opioid treatment within hours of injury. We found that (1) GCS scores were not significantly associated with PTSD; (2) longitudinal modeling using four (yearly) time points showed significantly reduced odds of PTSD for patients treated with morphine (vs fentanyl) across years (adjusted odds ratio = 0.40; 95% confidence interval = 0.17-0.94); (3) reduced PTSD prevalence for morphine (vs IV fentanyl; morphine = 25%, fentanyl = 59%, p < 0.05) was significant, specifically among patients with traumatic brain injury during the first 2 yr postinjury; and (4) PTSD prevalence, but not other disorders (e.g., mood), increased between year 1 (PTSD = 18%) and years 2 through 4 postinjury (PTSD range = 30%-32%).

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Midterm Health and Personnel Outcomes of Recent Combat Amputees

Abstract: Combat amputees had a complex set of outcomes supporting the continued need for military amputee care programs.

Cited by 49 publications

References 29 publications

Effect of traumatic brain injury among U.S. servicemembers with amputation

Effect of traumatic brain injury among U.S. servicemembers with amputation

Heterotopic ossification in combat amputees from Afghanistan and Iraq wars: Five case histories and results from a small series of patients

Glasgow Coma Scale scores, early opioids, and 4-year psychological outcomes among combat amputees

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