title: Initial injury severity and social factors determine ability to deploy after combat-related amputation.
abstract: OBJECTIVE
  While many recent publications have examined the ability of amputees to return to active duty, it remains largely unknown why few amputees deploy after amputation and many amputees do not. The purpose of this study is to examine what predictor(s) exist for whether or not an amputee will deploy after sustaining a combat-related amputation.
  
  
  METHODS
  All U.S. Service members who sustained major extremity amputations from September 2001 through July 2011 were analysed. Amputation level(s), mechanism of injury, time interval to amputation, age, rank, Physical Evaluation Board (PEB) disposition and ability to deploy after amputation were determined.
  
  
  RESULTS
  Deployment information after amputation was obtained for 953 amputees. There were 47 (5%) amputees who deployed. There were no significant differences amongst service branches for the deployment of amputees (p > 0.2). Amputees who underwent their amputation on the same day of their injury were significantly less likely to deploy after amputation than those who had their amputation on the day of injury (p = .01). Deployed amputees had significantly lower Injury Severity Scores than amputees who did not deploy (15.98 vs 20.87, p < 0.01) and officers were significantly (p < .01) more likely to deploy and the average age of amputees who deployed was significantly higher than those who did not (27.5 vs 25.1, p < .01). Lastly, those amputees who sustained a transtibial amputation were significantly more likely to deploy than all other amputation levels (p < .01). Nine out of 19 (47%) Special Forces amputees were able to deploy.
  
  
  CONCLUSIONS
  The vast majority of amputees do not able to deploy after undergoing amputation. The main predictors of deploying after sustaining a combat-related amputation appear to be: sustaining a transtibial amputation, being of senior rank or age and being a member of the Special Forces. Many of these factors appear to be non-treatment related and highlight the importance that individual and social factors play in the recovery of severe injuries.
authors.affiliation: San Antonio Military Medical Center, Fort Sam Houston, TX, USA. Electronic address: chad.a.krueger4.mil@mail.mil.
authors.forename: Chad A
authors.initials: CA
authors.lastname: Krueger
authors.affiliation: United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA. Electronic address: joseph.c.wenke.civ@mail.mil.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Wenke
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000328:Adult; D055826:Afghan Campaign 2001-; D000671:Amputation, Surgical / Q000523:psychology / Q000534:rehabilitation / Q000706:statistics & numerical data; D000674:Amputees / Q000523:psychology* / Q000534:rehabilitation; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D054542:Iraq War, 2003-2011; D008016:Life Change Events; D008297:Male; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D062707:Return to Work / Q000523:psychology* / Q000706:statistics & numerical data; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology* / Q000523:psychology / Q000534:rehabilitation; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000523:psychology* / Q000534:rehabilitation / Q000601:surgery
keywords: Amputation; Amputee activity; Amputee deployment; Amputee level of function; Mangled extremity