Postinjury Care and Complications Among U.S. Military Women With Combat-Related Major Limb Traumatic Amputation.

BACKGROUND: U.S. servicewomen may be at greater risk of injury in future conflicts as they integrate into combat occupations. More than 1,000 servicewomen were wounded during military conflicts in Iraq and Afghanistan. Some women sustained traumatic amputations, and research on their postinjury health is needed. OBJECTIVE: To describe acute care, complications, and health care utilization among servicewomen with combat-related amputations, comparing them with injured men. METHODS: In this retrospective matched-pairs study, women were identified from the Expeditionary Medical Encounter Database between 2003 and 2012 and matched with men on amputation injuries, injury severity, and age. Differences were assessed with nonparametric tests for paired data. RESULTS: Of 20 women identified for analysis, 13 received tourniquets, three were administered procoagulants, and six had massive transfusions. Women averaged 3.4 (SD = 1.6) postinjury complications, and the most frequent were heterotopic ossification (n = 17), posthemorrhagic anemias (n = 13), and bacterial wound infections (n = 10). Acute care and complications were similar among men. Women averaged more acute care days (M = 49.8, SD = 30.6) than men (M = 46.1, SD = 27.4) but fewer intensive care unit days (women: M = 2.6, SD = 4.0; men: M = 4.4, SD = 8.3). No statistical differences were observed. CONCLUSION: Postinjury care among servicewomen with combat-related amputations was comparable with servicemen, and complications were common. This information can aid providers and nursing staff in the management of these injuries.

Time Since Injury as a Factor in Post-Concussion Symptom Reporting among Military Service Members with Blast-Related Concussion.

Over the last decade, much research has been devoted to concussion among military personnel. Post-concussion symptoms after blast-related concussion are common, but it is unknown whether symptom reporting differs over time. This study's objective was to assess the relationship between time since injury and post-concussion symptom reporting. We conducted a retrospective review of existing records to identify service members who experienced blast-related concussion during deployment between 2007 and 2012 and who responded to a Post-Deployment Health Assessment (PDHA). The study population included 3690 military personnel grouped by time between injury and PDHA completion: 1-90 days (45.3%, n = 1,673), 91-180 days (33.0%, n = 1,216), or 181-365 days (21.7%, n = 801). Post-concussion symptoms assessed on the PDHA included headache, tinnitus, memory problems, concentration problems, difficulty making decisions, irritability, dizziness, and sleep problems. All post-concussion symptoms were higher for 91-180 days and 181-365 days after injury relative to 1-90 days, with the exception of dizziness. After adjustment for loss of consciousness, mental health comorbidity, and other covariates, the odds of reporting three or more post-concussion symptoms were significantly higher in those who completed the PDHA 91-180 days (odds ratio: 1.29; 95% confidence interval: 1.09-1.51) or 181-365 days after injury (odds ratio: 1.33; 95% confidence interval: 1.09-1.61), compared with the 1-90 days group. These findings suggest that refinements to in-theater medical care may be needed to reduce post-concussion symptom burden and improve the prospect of concussion recovery.

Serious Inhalation Injuries From Military Operations in Afghanistan, Iraq, and Syria.

OBJECTIVE: To characterize serious inhalation injuries seen during recent military operations, and assess whether bronchoscopic severity findings were associated with clinical presentation and outcomes. METHODS: Service members who suffered inhalation injuries while deployed to Iraq, Afghanistan, or Syria from 2001-2018 were identified using ICD-9 and 10 codes from the Expeditionary Medical Encounter Database (EMED), which is abstracted from patient records in forward-deployed medical facilities. Further information including demographics, mechanism of injury, mortality, total burn surface area (TBSA), degree of facial burn, total Injury Severity Score (ISS), and first post-injury bronchoscopy notes were collected. Patients were excluded with ISS less than 16 or without sufficient details regarding bronchoscopy. Injuries were grouped based on bronchoscopic Abbreviated Injury Scores (AIS) into low-grade (AIS of 1), moderate-grade (AIS of 2), or high-grade (AIS of 3 or 4). RESULTS: 91 patients met inclusion criteria, with no significant differences in age, gender, paygrade, or service branch between degrees of injury. There were no statistical correlations between grade of injury and battle versus non-battle injury, blast versus non-blast mechanism, TBSA, or degree of facial burn. High-grade injuries had significantly higher ISS than low or moderate-grade injuries. After adjusting for ISS, the odds ratio of death was 10.4 (95% CI 1.47 to 74.53) for those with high-grade and 3.7 (95% CI 0.45 to 32.30) for those with moderate-grade compared to low-grade injuries. CONCLUSION: In this cohort of deployed military members with inhalation injuries, initial bronchoscopic severity findings are strongly associated with mortality even after adjusting for ISS. The AIS may be an important prognostic tool in all of those with serious inhalation injuries.