Nonfatal Injuries From Falls Among U.S. Military Personnel Deployed for Combat Operations, 2001-2018.

INTRODUCTION: Falls are a leading mechanism of injury. Hospitalization and outpatient clinic visits due to fall injury are frequently reported among both deployed and non-deployed U.S. Military personnel. Falls have been previously identified as a leading injury second only to sports and exercise as a cause for non-battle air evacuations. MATERIALS AND METHODS: This retrospective study analyzed the Department of Defense Trauma Registry fall injury data from September 11, 2001 to December 31, 2018. Deployed U.S. Military personnel with fall listed as one of their mechanisms of injury were included for analysis. RESULTS: Of 31,791 injured U.S. Military personnel captured by the Department of Defense Trauma Registry within the study time frame, a total of 3,101 (9.8%) incurred injuries from falls. Those who had fall injuries were primarily 21 to 30 years old (55.4%), male (93.1%), Army (75.6%), and enlisted personnel (56.9%). The proportion of casualties sustaining injuries from falls generally increased through the years of the study. Most fall injuries were classified as non-battle injury (91.9%). Falls accounted for 24.2% of non-battle injury hospital admissions with a median hospital stay of 2 days. More non-battle-related falls were reported in Iraq-centric military operations (62.7%); whereas more battle-related falls were reported in Afghanistan-centric military operations (58.3%). CONCLUSIONS: This study is the largest analysis of deployed U.S. Military personnel injured by falls to date. Highlighted are preventive strategies to mitigate fall injury, reduce workforce attrition, and preserve combat mission capability. LEVEL OF EVIDENCE: Level III Epidemiologic.

How the Implementation of a Battlefield Clinical Practice Guideline Affects Documentation Practice and Informs Future Research Initiatives: Spinal Injuries and Cervical Collars.

INTRODUCTION: In 2010, the Joint Trauma System published a clinical practice guideline (CPG) for providing care to patients with suspicion of spinal cord injury. The CPG advocated for liberal use of cervical collars and adequate documentation of the practice. This performance improvement project examined C-spine CPG adherence in both the prehospital and military treatment facility (MTF) settings. Understanding challenges in CPG adherence facilitates evaluation of future CPGs and their success at implantation of the clinical guidance. MATERIALS AND METHODS: The Department of Defense Trauma Registry was used to identify US Military casualties meeting the criteria for cervical collar placement between January 1, 2007 and December 31, 2018. Criteria for cervical collar placement were defined as any patient who experienced a mechanism of injury relating to an explosion, fall, or motor-vehicle-related injury. Any patients with an AIS severity score greater than 1 to the head or having any ICD injury codes related to either upper spinal cord or head injury were also considered for inclusion. Adherence of cervical collar placement was defined by documented ICD codes or prehospital documentation of cervical collar placement as captured in the registry. RESULTS: A total of 14,837 patients were identified for possible cervical collar placement and 3,317 had verifiable documentation of having a C-collar placed. Documented C-collar placement was higher after the publication of the clinical practice guideline in 2010 (29% vs. 15%, p < 0.0001). CPG publication was associated with cervical collar application (odds ratio: 2.50, 95% CI: 2.29-2.72). CONCLUSION: Application of cervical collars has increased significantly, since the initial publication of the spine injury CPG. Current gaps include valid and reliable identification of patients warranting specific clinical interventions and documentation of patient care. Currently, lack of documentation is reported as nonadherence, but it remains unknown if these missing clinical data accurately portray nonadherence or adherence with lack of documentation. Future research and resources would benefit and expand the results collected in this paper, and cement the importance of CPG publication and adherence.

The lone S41 family C-terminal processing protease in Staphylococcus aureus is localized to the cell wall and contributes to virulence.

Staphylococcus aureus is a versatile pathogen of humans and a continued public health concern due to the rise and spread of multidrug-resistant strains. As part of an ongoing investigation into the pathogenic mechanisms of this organism we previously demonstrated that an intracellular N-terminal processing protease is required for S. aureus virulence. Following on from this, here we examine the role of CtpA, the lone C-terminal processing protease of S. aureus. CtpA, a member of the S41 family, is a serine protease whose homologues in Gram-negative bacteria have been implicated in a range of biological functions, including pathogenesis. We demonstrate that S. aureus CtpA is localized to the bacterial cell wall and expression of the ctpA gene is maximal upon exposure to conditions encountered during infection. Disruption of the ctpA gene leads to decreased heat tolerance and increased sensitivity when exposed to components of the host immune system. Finally we demonstrate that the ctpA(-) mutant strain is attenuated for virulence in a murine model of infection. Our results represent the first characterization of a C-terminal processing protease in a pathogenic Gram-positive bacterium and show that it plays a critical role during infection.