title: Evaluation of the Effectiveness of the 2008 Postsplenectomy Vaccination Joint Theater Trauma System Clinical Practice Guideline.
abstract: OBJECTIVE
  Postsplenectomy vaccination (PSV) in an austere environment to minimize overwhelming postsplenectomy infection is challenging. We evaluated the clinical impact of a March 2008 clinical practice guideline (CPG) dictating immediate PSV at North American Treaty Organization Role 3 medical treatment facilities and subsequent complications.
  
  
  METHODS
  Utilizing U.S. military medical databases, we characterized all U.S. patients with a splenic injury from November 2002 to January 2012 by their surgical management: laparotomy with splenectomy (LWS), laparotomy without splenectomy, or nonoperative management. Relevant data including demographics, vaccinations, and documented bacterial and fungal isolates were obtained.
  
  
  RESULTS
  LWS comprised 63.6% of the 409 patients with a splenic injury from 2002 to 2012. The implementation of the PSV CPG improved overall vaccination compliance from 48.9% pre-PSV CPG to 86.9% post-PSV CPG (p < 0.01). It was found that 1.3% (2/159) of completely vaccinated LWS patients compared with 0% (0/101) of the incompletely vaccinated LWS patients had Streptococcus pneumoniae isolates in 391.0 and 251.4 follow-up years, respectively (p = 0.52). No Neisseria meningitidis or Haemophilus influenzae isolates were identified.
  
  
  CONCLUSIONS
  PSV CPG implementation improved theater vaccination without increasing the incidence of encapsulated organisms.
authors.affiliation: San Antonio Military Medical Center Department of General Surgery, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Mitchell
authors.affiliation: United States Army Institute of Surgical Research, 3698 Chambers Pass STE B, JBSA Fort Sam Houston, TX 78234-7767.
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Wallum
authors.affiliation: San Antonio Military Medical Center Department of General Surgery, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: White
authors.affiliation: San Antonio Military Medical Center Department of General Surgery, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234.
authors.forename: Kelly E
authors.initials: KE
authors.lastname: Sanders
authors.affiliation: United States Army Institute of Surgical Research, 3698 Chambers Pass STE B, JBSA Fort Sam Houston, TX 78234-7767.
authors.forename: James K
authors.initials: JK
authors.lastname: Aden
authors.affiliation: United States Army Institute of Surgical Research, 3698 Chambers Pass STE B, JBSA Fort Sam Houston, TX 78234-7767.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Bailey
authors.affiliation: San Antonio Military Medical Center Department of General Surgery, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234.
authors.forename: Lorne H
authors.initials: LH
authors.lastname: Blackbourne
authors.affiliation: San Antonio Military Medical Center Department of Infectious Disease, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234.
authors.forename: Clinton K
authors.initials: CK
authors.lastname: Murray
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008887:Military Medicine / Q000379:methods*; D008889:Military Personnel; D011182:Postoperative Care / Q000379:methods*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013156:Splenectomy; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014611:Vaccination / Q000379:methods*; D055815:Young Adult