Citation

Shin E, Evans KN, Fleming ME. J. Orthop. Trauma 2013; 27(7): 419-423.

Affiliation

1Orthopaedic Surgery Service, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20889 2Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.

Copyright

(Copyright © 2013, Lippincott Williams and Wilkins)

DOI

10.1097/BOT.0b013e318279fa4f

PMID

23114417

Abstract

OBJECTIVE:: Assess effectiveness of Injury Severity Score (ISS) in predicting injury severity in combat-related amputations Design: Retrospective evaluation of prospectively collected data Setting: Military medical center Patients: 109 patients with major extremity amputations sustained in overseas combat Intervention: Standard combat casualty care MAIN OUTCOME MEASUREMENTS:: Difference in injury severity as measured by ISS, numbers of extremity(s) amputated, number of associated injuries, blood products utilized, ICU length of stay (ILOS), hospital length of stay (HLOS) in those with an upper extremity amputation (UEA) compared to those with an isolated lower extremity amputation (LEA). RESULTS:: Thirteen patients (11.9%) sustained at least one UEA. Patients with an UEA had a greater number of amputations per casualty compared to patients with a lower extremity alone (2.5 versus 1.5; p <0.001). The mean HLOS (p=0.02) and ILOS (p=0.02) were significantly greater in those with an UEA. Mean blood product utilization was also significantly greater in those with an upper extremity amputation (p<0.05). There was no difference in Injury Severity Score between the two groups (p>0.05). CONCLUSION:: The presence of an UEA is associated with increased injury severity as evident by increased ICU requirements, blood product utilization and hospital length of stay. ISS underestimates the severity of injury and therefore resource utilization in patients with multiple combat related amputations. Recognition of this limitation in addition to the development of a military-specific ISS is required for more effective resource utilization in order to continue to improve combat casualty care.

Language: en