Management of Acute Diarrheal Illness During Deployment: A Deployment Health Guideline and Expert Panel Report.

BACKGROUND: Acute diarrheal illness during deployment causes significant morbidity and loss of duty days. Effective and timely treatment is needed to reduce individual, unit, and health system performance impacts. METHODS: This critical appraisal of the literature, as part of the development of expert consensus guidelines, asked several key questions related to self-care and healthcare-seeking behavior, antibiotics for self-treatment of travelers' diarrhea, what antibiotics/regimens should be considered for treatment of acute watery diarrhea and febrile diarrhea and/or dysentery, and when and what laboratory diagnostics should be used to support management of deployment-related travelers' diarrhea. Studies of acute diarrhea management in military and other travelers were assessed for relevance and quality. On the basis of this critical appraisal, guideline recommendations were developed and graded by the Expert Panel using good standards in clinical guideline development methodology. RESULTS: New definitions for defining the severity of diarrhea during deployment were established. A total of 13 graded recommendations on the topics of prophylaxis, therapy and diagnosis, and follow-up were developed. In addition, four non-graded consensus-based statements were adopted. CONCLUSIONS: Successful management of acute diarrheal illness during deployment requires action at the provider, population, and commander levels. Strong evidence supports that single-dose antimicrobial therapy is effective in most cases of moderate to severe acute diarrheal illness during deployment. Further studies are needed to address gaps in available knowledge regarding optimal therapies for treatment, prevention, and laboratory testing of acute diarrheal illness.

Service Member Completion of Laboratory Follow-Up After Emergency Transfusion With Freshly Collected Blood Products.

BACKGROUND: Transfusion of freshly collected blood products (FCBP) is sometimes necessary to save service member (SM) lives in austere deployed environments. Recipients of FCBPs are administratively tracked and offered serial serologic testing via the Armed Services Blood Program "Blood Look Back" (BLB) program to assure early detection of post-transfusion infections. OBJECTIVES: This study evaluates demographic and clinical features influencing SM completion of recommended BLB laboratory follow-up after transfusion with FCBPs. METHODS: Using BLB programmatic data, a retrospective cohort study was performed examining U.S. SM transfusion recipients of FCBPs from June 1, 2006, through December 31, 2012. Multivariate logistic regression was used to examine clinical and demographic factors influencing completion of BLB recommended follow-up. RESULTS: Of eligible subjects, 69% (n = 778) completed 12-month recommended BLB follow-up. As compared to other services, U.S. soldiers demonstrated greatest compliance with BLB recommendations with 71.7% completing recommended follow-up. As compared to the Army, SMs from the Air Force (odds ratio [OR] = 0.35, 95% confidence interval [CI] = 0.15-0.85), Marine Corps (OR = 0.51, 95% CI = 0.37-0.71), and Navy (OR = 0.29, 95% CI = 0.11-0.74) were less likely to complete recommended follow-up; however, differences in follow-up among the services attenuated over time. Neither the type of FCBP (platelets versus whole blood) nor the volume of FCBP transfused significantly altered SM likelihood of competing recommended follow-up. CONCLUSIONS: More than 2 out of 3 SMs completed recommended 12-month BLB follow-up after transfusion with FCBPs with greater compliance in Army SMs compared to other services. Programmatic changes implemented by the BLB program were temporally associated with increased SM compliance with recommended follow-up as well as reduction of disparities in follow-up observed between the services.