McDonald JR, Liang SY, Li P, Maalouf S, Murray CK, Weintrob AC, Schnaubelt ER, Kuhn J, Ganesan A, Bradley W, Tribble DR. Clin. Infect. Dis. 2018; 67(8): 1205-1212.
Affiliation
Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
BACKGROUND: Infectious complications related to deployment trauma significantly contribute to the morbidity and mortality impacting wounded service members. The Trauma Infectious Disease Outcomes Study (TIDOS) collects data on U.S. military personnel injured in Iraq and Afghanistan in an observational cohort study of infectious complications. Patients enrolled in TIDOS may also consent to follow-up through the Department of Veterans Affairs (VA). We present data from the first 337 TIDOS enrollees to receive VA healthcare.
METHODS: Data were collected from the Department of Defense (DoD) Trauma Registry, TIDOS infectious disease module, DoD and VA electronic medical records, and telephone interview. Cox proportional hazard analysis was performed to identify predictors of post-discharge infections related to deployment trauma.
RESULTS: Among the first 337 TIDOS enrollees who entered VA healthcare, 111 (33%) had 244 trauma-related infections during their initial trauma hospitalization (2.1 infections per 100 person-days). Following initial discharge, 127 (38%) subjects had 239 trauma-related infections (170 during DoD follow-up and 69 during VA time). Skin and soft-tissue infections and osteomyelitis were predominant both during and after the initial trauma hospitalization. In the multivariate model, a shorter time to development of a new infection following discharge was independently associated with injury severity score ≥10 and occurrence of ≥1 inpatient infection during initial trauma hospitalization.
CONCLUSIONS: Incident infections related to deployment trauma continue well after initial hospital discharge and into VA healthcare. Overall, 38% of enrolled patients developed a new trauma-related infection after their initial hospital discharge with 29% occurring after the patient left military service.