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Limb Outcomes Following Combat Trauma.

Rivera, Jessica Cross.

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Limb Outcomes Following Combat Trauma.

紀錄類型:	書目-電子資源 : Monograph/item
正題名/作者:	Limb Outcomes Following Combat Trauma./
作者:	Rivera, Jessica Cross.
出版者:	Ann Arbor : ProQuest Dissertations & Theses, : 2018,
面頁冊數:	177 p.
附註:	Source: Dissertation Abstracts International, Volume: 80-02(E), Section: B.
Contained By:	Dissertation Abstracts International80-02B(E).
標題:	Medicine. -
電子資源:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=10637825
ISBN:	9780438400788

Limb Outcomes Following Combat Trauma.
Rivera, Jessica Cross.

Limb Outcomes Following Combat Trauma. - Ann Arbor : ProQuest Dissertations & Theses, 2018 - 177 p.

Source: Dissertation Abstracts International, Volume: 80-02(E), Section: B.

Thesis (Ph.D.)--The University of Texas Health Science Center at San Antonio, 2018.

Extremity wounds are the most common injuries sustained in combat and are typically due to high-energy explosion mechanisms. Clinical practice guidelines and technological options for extremity wound treatment have evolved during recent conflicts in Iraq and Afghanistan. However, there are only a few guidelines that address deployed orthopaedic care despite the heavy burden of extremity injuries. This research aimed to examine a retrospective cohort of combat casualties from an early war period (January 2003-December 2009) and a later war period (January 2010-December 2015) and determine if the frequency of complication outcomes following combat extremity trauma decreased after clinical practice guideline changes. Outcomes considered were wound complications, neuromuscular fasciotomy-related complications, heterotopic ossification, and late amputation. Adherence to clinical practice guidelines was described by a latent index calculated by principal component analysis and tested for association with these outcomes using principal component regression. Clinical practice guideline adherence was also examined year to year to determine inflection points in actual care rendered using segmented regression analysis. Finally, service connected disability as defined by the Veteran's Administration was described for those injured during early and late war years.

ISBN: 9780438400788Subjects--Topical Terms:

641104
Medicine.

Limb Outcomes Following Combat Trauma.
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520 $a Extremity wounds are the most common injuries sustained in combat and are typically due to high-energy explosion mechanisms. Clinical practice guidelines and technological options for extremity wound treatment have evolved during recent conflicts in Iraq and Afghanistan. However, there are only a few guidelines that address deployed orthopaedic care despite the heavy burden of extremity injuries. This research aimed to examine a retrospective cohort of combat casualties from an early war period (January 2003-December 2009) and a later war period (January 2010-December 2015) and determine if the frequency of complication outcomes following combat extremity trauma decreased after clinical practice guideline changes. Outcomes considered were wound complications, neuromuscular fasciotomy-related complications, heterotopic ossification, and late amputation. Adherence to clinical practice guidelines was described by a latent index calculated by principal component analysis and tested for association with these outcomes using principal component regression. Clinical practice guideline adherence was also examined year to year to determine inflection points in actual care rendered using segmented regression analysis. Finally, service connected disability as defined by the Veteran's Administration was described for those injured during early and late war years.
520 $a Increased clinical practice guideline adherence for wound management as defined by the principal component index was positively associated with greater odds of wound complications. Use of negative pressure wound dressings, a technology translated to deployed military environments in later war years, was positively associated with wound complications. Increased adherence to the wound care guidelines was also positively associated, though lesser so, with heterotopic ossification. Greater adherence to fasciotomy guidelines was associated with greater odds of neuromuscular complications. Late amputations were uncommon; and neither the guideline adherence indexes nor presence of an aforementioned outcome were associated with late amputations. Year to year inflections in clinical practice guideline adherence were not largely not significant except for a positive change in intercept for negative pressure wound therapy use and fasciotomies between 2009 and 2010. These years correspond to the increased deployment of the negative wound pressure technology and a training emphasis on far- forward fasciotomies. Service connected disabilities were not different for subjects wounded during early versus late war years. These results emphasize the importance of critical guideline evaluation and highlight that individual surgeon experience, training, and clinical decision making cannot be fully accounted in deployed guidelines. Adverse outcomes occur after severe injuries and disability ensues.
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