Venous thromboembolism after traumatic amputation: an analysis of 366 combat casualties.

BACKGROUND: We sought to determine the incidence, risk factors, and time course for deep vein thrombosis and pulmonary embolism (DVT/PE) after combat-related major limb amputations. METHODS: Patients with amputation in Iraq or Afghanistan from 2009 through 2011 were eligible. Details of postinjury care, date of diagnosis of DVT/PE, and injury specific data were collected. Military databases and chart reviews were used. RESULTS: In 366 patients, 103 (28%) had DVT/PE; PE was diagnosed in 59 (16%) and DVT in 59 (16%). Most DVT (69%) and PE (66%) occurred within 10 days. Increasing ventilator days (odds ratio [OR], 1.97; 95% CI, 1.16 to 3.37) and units of blood transfused (OR, 1.72; 95% CI, 1.11 to 2.68) were associated with DVT. Increasing units of fresh-frozen plasma were associated with PE (OR, 1.31; 95% CI, 1.10 to 1.55). CONCLUSIONS: The incidence of DVT/PE is high after combat-related amputation. Most DVT/PE occur early and prophylaxis is indicated.

A comparison of health outcomes for combat amputee and limb salvage patients injured in Iraq and Afghanistan wars.

BACKGROUND: Treatment of military combatants who sustain leg-threatening injuries remains one of the leading challenges for military providers. The present study provides systematic health outcome data to inform decisions on the definitive surgical treatment, namely amputation versus limb salvage, for the most serious leg injuries. METHODS: This was a retrospective analysis of health records for patients who sustained serious lower-extremity injuries in the Iraq and Afghanistan conflicts, 2001 to 2008. Patients had (1) amputation during the first 90 days after injury (early amputees, n = 587), (2) amputation more than 90 days after injury (late amputees, n = 84), or (3) leg-threatening injuries without amputation (limb salvage [LS], n = 117). Injury data and health outcomes were followed up to 24 months. RESULTS: After adjusting for group differences, early amputees and LS patients had similar rates for most physical complications. Early amputees had significantly reduced rates of psychological diagnoses (posttraumatic stress disorder, substance abuse) and received more outpatient care, particularly psychological, compared with LS patients. Late amputees had significantly higher rates of many mental and physical health diagnoses, including prolonged infections and pain issues, compared with early amputees or LS patients. CONCLUSION: Early amputation was associated with reduced rates of adverse health outcomes relative to late amputation or LS in the short term. Most evident was that late amputees had the poorest physical and psychological outcomes. These findings can inform health care providers of the differing clinical consequences of early amputation and LS. These results indicate the need for separate health care pathways for early and late amputees and LS patients.

Premilitary tobacco use by male Marine Corps recruits.

Recognizing both the medical and operational costs of tobacco use, the Department of Defense has made tobacco cessation a top health promotion priority. Military tobacco rates remain high, however, especially among younger personnel and, particularly, in the Marine Corps. Tobacco is prohibited during basic training, but relapse is common following boot camp graduation. The objective of this study was to determine patterns and prevalence of tobacco use among Marine Corps recruits before entering basic training. Over a period of 14 months, 15,689 graduating male recruits completed a survey of their preservice tobacco use. Approximately 81% reported having tried tobacco at least once and 57% were classified as at-risk users. Compared to their civilian peers, more recruits were daily users and many more used smokeless tobacco. Approximately 67% of users evidenced at least one indicator of dependence. There is a clear need for additional tobacco cessation efforts to target this high-risk population.