Citation

Nnamani NS, Janak JC, Hudak SJ, Rivera JC, Lewis EA, Soderdahl DW, Orman JA. J. Trauma Acute Care Surg. 2016; ePub(ePub): ePub.

Affiliation

US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA (N.S.N., J.C.J., J.C.R.); Urology Service, Department of Surgery, San Antonio Military Medical Center, JBSA Fort Sam Houston, Texas, USA (S.J.H.); Department of Orthopaedics, San Antonio Military Medical Center, JBSA Fort Sam Houston, Texas, USA (J.C.R.); Technology Office, Defence Equipment and Support, Ministry of Defence, Bristol, United Kingdom (E.A.L.); Surgical Services, San Antonio Military Medical Center, JBSA Fort Sam Houston, Texas, USA (D.W.S.); Joint Trauma System, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA (J.A.O.); Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA (J.A.O.).

Copyright

(Copyright © 2016, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000001122

PMID

27280938

Abstract

BACKGROUND: In Operations Enduring Freedom and Iraqi Freedom (OEF/OIF), genitourinary (GU) wounds have occurred in unprecedented numbers. Severe concomitant injuries, including extremity amputations, are common. The epidemiology of GU injury and extremity amputation in OEF/OIF has not been described.

MATERIALS AND METHODS: The Department of Defense Trauma Registry (DoDTR) was queried from October 2001 through August 2013 to identify all surviving US male service members with GU injuries sustained in OEF/OIF. GU injury was defined as sustaining one or more injuries to any organ or structure within the genitourinary and/or reproductive system(s) based on ICD-9-CM diagnosis codes. Injury severity was quantified based on Abbreviated Injury Scale (AIS) scores and overall Injury Severity Scores (ISS). The incidence, nature, and severity of GU injuries and extremity amputations were described.

RESULTS: Of the 1,367 service members with GU injury included in this analysis, 433 (31.7%) had one or more extremity amputations. The majority of GU injuries were to the external genitalia [scrotum (55.6%), testes (33.0%), penis (31.0%), and urethra (9.1%)] vs. the kidneys (21.1%). Those with amputation(s) had greater GU injury severity (AIS ≥ 3) than those without amputations (50.1% vs. 30.5% respectively; p<0.001). Approximately 3.0% of male service members with GU injury had an upper extremity amputation only, 8.9% had both lower and upper extremity amputation(s), and 19.4% had lower extremity amputation(s) only. Of the 387 patients with GU injury and lower extremity amputations, 87 (22.5%) had amputations below the knee and 300 (77.5%) had amputation(s) at/above the knee.

CONCLUSION: In OEF/OIF, concomitant GU injury and extremity amputation are common and have serious implications for health and quality of life. This wounding pattern presents new challenges to the military medical and research & development communities to prevent, mitigate, and treat these battlefield injuries. LEVEL OF EVIDENCE: Epidemiologic study, level III.

Language: en