The Navy-Marine Corps Combat Trauma Registry

Galarneau, Michael R.; Hancock, William C.; Konoske, Paula; Melcer, Ted; Vickers, Ross R.; Walker, G. J.; Zouris, James M.

doi:10.7205/milmed.171.8.691

Cited by 127 publications

(73 citation statements)

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“…For all patients, we extracted the following demographic and injury information from their medical records: age, sex, mechanism of injury, anatomic location of amputation, injury severity scores [14], and associated complications. We have routinely coded injuries and complications of recent combat-injured patients [15]. We did not record soft-tissue treatments (e.g., irrigations, duration of negative pressure-wound therapy) because two previous studies found little evidence supporting their role in the development of HO [1,3].…”

Section: Methodsmentioning

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

JRRD

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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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Section: Methodsmentioning

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

JRRD

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“…The GCS scores, medication type, dosage, route of administration, and associated level of care for these data were extracted from in-theater patient encounter forms by trauma research nurses per standard EMED procedures [33]. Patients usually arrive at level 2 care 1-6 h postinjury, while arrival at level 3 care typically occurs 2-24 h postinjury.…”

Section: Methodsmentioning

confidence: 99%

“…NHRC's Expeditionary Medical Encounter Database (EMED), formerly known as the Navy-Marine Corps Combat Trauma Registry [33], gathers data from NavyMarine Corps levels 1, 2, and 3 military treatment facilities and is supplemented by level 3 data from the Theater Medical Data Store and medical records from levels 4 and 5 facilities treating all military services. The five levels of combat care begin at or near the point of injury (level 1, first aid Army medics/Navy corpsman).…”

Section: In-theater Injury and Medication Datamentioning

confidence: 99%

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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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“…These databases contain standardized codes determined by medical providers and employers that are regularly updated [28][29]. We used the following codes to identify combat-related amputations in OIF/OEF:…”

Section: Identification Of Subjectsmentioning

confidence: 99%

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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The Navy-Marine Corps Combat Trauma Registry

Cited by 127 publications

References 0 publications

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

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

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

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