Trauma-related amputations in war and at a civilian major trauma centre-comparison of care, outcome and the challenges ahead.
The Afghanistan conflict has resulted in a large number of service personnel sustaining amputations. Whilst obvious differences exist between military and civilian trauma-related amputations both settings result in life changing injuries. Comparisons offer the potential of advancement and protection of the knowledge gained during the last 12 years. This paper compares the military and civilian trauma-related amputee cohorts' demographics, management and rehabilitation outcomes measures. The UK military Joint Theatre Trauma Registry and a civilian major trauma centre database of trauma-related amputees were analysed. 255 military and 24 civilian amputees were identified. A significant difference (p>0.05) was seen in median age (24, range 18-43, vs. 48, range 24-87 years), mean number of amputations per casualty (1.6±SD 0.678 vs. 1±SD 0.0), mean ISS (22±SD 12.8 vs. 14.7±SD 15.7) and gender (99% males vs. 78%). Rehabilitation outcome measures recorded included the Special Interest Group in Amputee Medicine score where the military group demonstrated significantly better scores (91% Grade E+ compared to 19%). Differences in patients underlying physiology and psychology, the military trauma system and a huge sustained investment in rehabilitation are all contributing factors for these differing outcomes. However the authors also believe that the use of a consultant-led MDT and central rehabilitation have benefited the military cohort in the acute rehabilitation stage and is reflected in the good short-term outcomes.
The Royal Centre for Defence Medicine, Birmingham, UK; The Royal British Legion Centre for Blast Injury Studies, Imperial College, London, UK. Electronic address: taffedwards100@hotmail.com.
D S
DS
Edwards
The Royal Centre for Defence Medicine, Birmingham, UK; Brighton and Sussex University Hospitals, Sussex, UK; Defence Medical Rehabilitation Centre, Headley Court, UK.
H C
HC
Guthrie
Brighton and Sussex University Hospitals, Sussex, UK; University of Brighton, Sussex, UK.
S
S
Yousaf
Defence Medical Rehabilitation Centre, Headley Court, UK.
M
M
Cranley
Brighton and Sussex University Hospitals, Sussex, UK; University of Brighton, Sussex, UK.
B A
BA
Rogers
The Royal British Legion Centre for Blast Injury Studies, Imperial College, London, UK; Defence Medical Group (South East), Frimley Park, UK.
J C
JC
Clasper
D000222:Adaptation, Physiological; D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000191:economics / Q000523:psychology / Q000534:rehabilitation; D000674:Amputees / Q000523:psychology* / Q000534:rehabilitation; D001186:Artificial Limbs; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000191:economics; D008297:Male; D008875:Middle Aged; D008887:Military Medicine; D008889:Military Personnel / Q000523:psychology / Q000706:statistics & numerical data*; D014193:Trauma Centers; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D014947:Wounds and Injuries / Q000523:psychology*; D055815:Young Adult
Amputation; Outcomes; Rehabilitation; Trauma; Trauma-Related amputations; War surgery