Abstract
BackgroundLimb injuries comprise 50-60% of U.S. Service member’s casualties of wars in Afghanistan and Iraq. Combat-related vascular injuries are present in 12% of this cohort, a rate 5 times higher than in prior wars. Improvements in medical and surgical trauma care, including initial in-theatre limb salvage approaches (IILS) have resulted in improved survival and fewer amputations, however, the long-term outcomes such as morbidity, functional decline, and risk for late amputation of salvaged limbs using current process of care have not been studied. The long-term care of these injured warfighters poses a significant challenge to the Department of Defense (DoD) and Department of Veterans Affairs (VA).Methods/DesignThe VA Vascular Injury Study (VAVIS): VA-DoD Extremity Injury Outcomes Collaborative, funded by the VA, Health Services Research and Development Service, is a longitudinal cohort study of Veterans with vascular extremity injuries. Enrollment will begin April, 2015 and continue for 3 years. Individuals with a validated extremity vascular injury in the Department of Defense Trauma Registry will be contacted and will complete a set of validated demographic, social, behavioral, and functional status measures during interview and online/ mailed survey. Primary outcome measures will: 1) Compare injury, demographic and geospatial characteristics of patients with IILS and identify late vascular surgery related limb complications and health care utilization in Veterans receiving VA vs. non-VA care, 2) Characterize the preventive services received by individuals with vascular repair and related outcomes, and 3) Describe patient-reported functional outcomes in Veterans with traumatic vascular limb injuries.DiscussionThis study will provide key information about the current process of care for Active Duty Service members and Veterans with polytrauma/vascular injuries at risk for persistent morbidity and late amputation. The results of this study will be the first step for clinicians in VA and military settings to generate evidence-based treatment and care approaches to these injuries. It will identify areas where rehabilitation medicine and vascular specialty care or telehealth options are needed to allow for better planning, resource utilization, and improved DoD-to-VA care transitions.
Highlights
Limb injuries comprise 50-60% of U.S Service member’s casualties of wars in Afghanistan and Iraq
The results of this study will be the first step for clinicians in Veterans Affairs (VA) and military settings to generate evidence-based treatment and care approaches to these injuries
It will identify areas where rehabilitation medicine and vascular specialty care or telehealth options are needed to allow for better planning, resource utilization, and improved Department of Defense (DoD)-to-VA care transitions
Summary
This study will provide key information about the current process of care for OEF/OIF/OND Veterans with polytrauma/vascular injuries at risk for persistent morbidity and late amputation. Using the DoDTR to identify injured Service members and a DoD-VA research team to determine the long term outcome of traumatic vascular injury repairs provides an unprecedented opportunity to define current processes of care and improve the evidence base for further treatment. Methods used in VAVIS can be applied to other health care problems encountered in combat casualty care to determine long term outcomes These studies have the potential to improve battlefield care, transitions of care between the DoD and VA, as well as to determine care teams within the VA to optimally treat these complex patients. All authors read and approved the final manuscript
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