title: Patient-based outcomes and quality of life after salvageable wartime extremity vascular injury.
abstract: OBJECTIVE
  To date, contemporary studies on wartime vascular trauma have focused on acute management strategies and early results, with no characterization of enduring functional limb salvage or its relation to quality of life. The objective of this study was to describe long-term, patient-based quality of life and function after extremity vascular injury (EVI).
  
  
  METHODS
  The Joint Theater Trauma Registry was queried for U.S. troops with EVI. Injury and management data was obtained and the Medical Outcomes Study Short Form 36 (SF-36) Health Survey administered after patient contact and consent. Demographic, injury, and management variables were analyzed and examined for correlation with the primary end points of favorable or unfavorable outcome defined by SF-36 Mental (MCS) or Physical Component Summary (PCS) scores of >42 or <42 (effect size ≥ 0.8).
  
  
  RESULTS
  Surveys were completed by 214 patients, who were a median age of 25 years (range, 19-52 years). The Injury Severity Score was 15.3 ± 8.6 and the Mangled Extremity Severity Score was 5.65 ± 1.4. Amputation-free survival was 84% at mean follow-up of 61 ± 24 months. Overall SF-36 PCS and MCS scores were 43.0 ± 9.2 and 46.6 ± 12.4, respectively, with 92 respondents (43%) reporting favorable outcomes on both MCS and PCS. On multivariate analysis, older age, severe extremity injury (Mangled Extremity Severity Scores ≥ 7), and chronic pain were predictive of unfavorable physical outcomes (P < .05). Presence of pain, nerve injury, and junior rank (<E7) were predictive of unfavorable MCS scores (P < .05). Higher educational background (baccalaureate or above) was associated with favorable outcome (P < .05).
  
  
  CONCLUSIONS
  This study reports the first long-term patient-centered outcomes data after wartime EVI. At 5 years after injury, quality-of-life measures are reduced compared with national norms. Understanding high-risk characteristics, both demographic- and injury-specific, that are associated with unfavorable outcomes will help guide future acute management and long-term recovery strategies.
authors.affiliation: 59th Clinical Research Division, Lackland Air Force Base, San Antonio, Tex; U.S. Army Institute of Surgical Research, Chambers Pass, Fort Sam Houston, Tex.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Scott
authors.affiliation: U.S. Army Institute of Surgical Research, Chambers Pass, Fort Sam Houston, Tex. Electronic address: zarthurs@mac.com.
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Arthurs
authors.affiliation: 59th Clinical Research Division, Lackland Air Force Base, San Antonio, Tex; U.S. Army Institute of Surgical Research, Chambers Pass, Fort Sam Houston, Tex; Academic Department of Military Surgery & Trauma, The Royal Centre for Defence Medicine, Birmingham, United Kingdom.
authors.forename: Adam
authors.initials: A
authors.lastname: Stannard
authors.affiliation: 59th Clinical Research Division, Lackland Air Force Base, San Antonio, Tex.
authors.forename: Howard M
authors.initials: HM
authors.lastname: Monroe
authors.affiliation: Division of Vascular Surgery, University of California at Davis, Sacramento, Calif; Norman M. Rich Department of Surgery, The Uniformed Services University of the Health Sciences, Bethesda, Md.
authors.forename: W Darrin
authors.initials: WD
authors.lastname: Clouse
authors.affiliation: 59th Clinical Research Division, Lackland Air Force Base, San Antonio, Tex; Academic Department of Military Surgery & Trauma, The Royal Centre for Defence Medicine, Birmingham, United Kingdom; Norman M. Rich Department of Surgery, The Uniformed Services University of the Health Sciences, Bethesda, Md.
authors.forename: Todd E
authors.initials: TE
authors.lastname: Rasmussen
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000367:Age Factors; D016009:Chi-Square Distribution; D059350:Chronic Pain / Q000209:etiology / Q000523:psychology; D005121:Extremities / Q000098:blood supply*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D054542:Iraq War, 2003-2011; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D008887:Military Medicine; D015999:Multivariate Analysis; D063868:Patient Outcome Assessment; D011788:Quality of Life; D012042:Registries; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D020196:Trauma, Nervous System / Q000209:etiology / Q000523:psychology; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D057772:Vascular System Injuries / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D055815:Young Adult