Combat-Related Extremity Wounds: Injury Factors Predicting Early Onset Infections
Abstract
We examined risk factors for combat-related extremity wound infections (CEWI) among U.S. military patients injured in Iraq and Afghanistan (2009–2012). Patients with ≥1 combat-related, open extremity wound admitted to a participating U.S. hospital (≤7 days postinjury) were retrospectively assessed. The population was classified based upon most severe injury (amputation, open fracture without amputation, or open soft-tissue injury defined as non-fracture/non-amputation wounds). Among 1271 eligible patients, 395 (31%) patients had ≥1 amputation, 457 (36%) had open fractures, and 419 (33%) had open soft-tissue wounds as their most severe injury, respectively. Among patients with traumatic amputations, 100 (47%) developed a CEWI compared to 66 (14%) and 12 (3%) patients with open fractures and open soft-tissue wounds, respectively. In a Cox proportional hazard analysis restricted to CEWIs ≤30 days postinjury among the traumatic amputation and open fracture groups, sustaining an amputation (hazard ratio: 1.79; 95% confidence interval: 1.25–2.56), blood transfusion ≤24 hours postinjury, improvised explosive device blast, first documented shock index ≥0.80, and >4 injury sites were independently associated with CEWI risk. The presence of a non-extremity infection at least 4 days prior to a CEWI diagnosis was associated with lower CEWI risk, suggesting impact of recent exposure to directed antimicrobial therapy. Further assessment of early clinical management will help to elucidate risk factor contribution. The wound classification system provides a comprehensive approach in assessment of injury and clinical factors for the risk and outcomes of an extremity wound infection.
Document Details
- Document Type
- Pub Defense Publication
- Publication Date
- Mar 01, 2019
- Source ID
- 10.1093/milmed/usy336
Entities
People
- Dan Lu
- Dana M. Blyth
- David R. Tribble
- Faraz Shaikh
- Joseph L Petfield
- Lauren Greenberg
- Laveta Stewart
- Margot Krauss
- Timothy J. Whitman
- William Bradley
Organizations
- Henry M. Jackson Foundation for the Advancement of Military Medicine
- Landstuhl Regional Medical Center
- National Institute of Allergy and Infectious Diseases
- National Institutes of Health
- San Antonio Military Medical Center
- Uniformed Services University of the Health Sciences
- United States Department of Defense
- United States Department of the Navy
- Walter Reed National Military Medical Center
- Westat