Shireman Paula K, Rasmussen Todd E, Jaramillo Carlos A, Pugh Mary Jo
Department of Surgery, Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center San Antonio, The South Texas Veterans Health Care System, 7703 Floyd Curl Drive, MC 7790, San Antonio, TX, 78229-3900, USA.
US Combat Casualty Care Research Program, Fort Detrick, Frederick, MD, 21702-5012, USA.
BMC Surg. 2015 Feb 3;15(1):13. doi: 10.1186/1471-2482-15-13.
Limb injuries comprise 50-60% of U.S. Service member's casualties of wars in Afghanistan and Iraq. Combat-related vascular injuries are present in 12% of this cohort, a rate 5 times higher than in prior wars. Improvements in medical and surgical trauma care, including initial in-theatre limb salvage approaches (IILS) have resulted in improved survival and fewer amputations, however, the long-term outcomes such as morbidity, functional decline, and risk for late amputation of salvaged limbs using current process of care have not been studied. The long-term care of these injured warfighters poses a significant challenge to the Department of Defense (DoD) and Department of Veterans Affairs (VA).
METHODS/DESIGN: The VA Vascular Injury Study (VAVIS): VA-DoD Extremity Injury Outcomes Collaborative, funded by the VA, Health Services Research and Development Service, is a longitudinal cohort study of Veterans with vascular extremity injuries. Enrollment will begin April, 2015 and continue for 3 years. Individuals with a validated extremity vascular injury in the Department of Defense Trauma Registry will be contacted and will complete a set of validated demographic, social, behavioral, and functional status measures during interview and online/ mailed survey. Primary outcome measures will: 1) Compare injury, demographic and geospatial characteristics of patients with IILS and identify late vascular surgery related limb complications and health care utilization in Veterans receiving VA vs. non-VA care, 2) Characterize the preventive services received by individuals with vascular repair and related outcomes, and 3) Describe patient-reported functional outcomes in Veterans with traumatic vascular limb injuries.
This study will provide key information about the current process of care for Active Duty Service members and Veterans with polytrauma/vascular injuries at risk for persistent morbidity and late amputation. The results of this study will be the first step for clinicians in VA and military settings to generate evidence-based treatment and care approaches to these injuries. It will identify areas where rehabilitation medicine and vascular specialty care or telehealth options are needed to allow for better planning, resource utilization, and improved DoD-to-VA care transitions.
在美国参与阿富汗和伊拉克战争的军人伤亡中，肢体损伤占50%-60%。该群体中12%存在与战斗相关的血管损伤，这一比例是以往战争的5倍。包括初始战场肢体挽救方法（IILS）在内的医疗和外科创伤护理的改善，已使生存率提高且截肢数量减少，然而，对于采用当前护理流程挽救的肢体，其长期结局，如发病率、功能衰退以及晚期截肢风险，尚未得到研究。对这些受伤战士的长期护理给美国国防部（DoD）和退伍军人事务部（VA）带来了重大挑战。
方法/设计：退伍军人事务部血管损伤研究（VAVIS）：由退伍军人事务部卫生服务研究与发展局资助的退伍军人事务部-国防部肢体损伤结局协作研究，是一项针对患有肢体血管损伤退伍军人的纵向队列研究。入组将于2015年4月开始，并持续3年。将联系国防部创伤登记处中经确认存在肢体血管损伤的个体，他们将在访谈以及在线/邮寄调查中完成一套经过验证的人口统计学、社会、行为和功能状态测量。主要结局指标将：1）比较接受IILS治疗患者的损伤、人口统计学和地理空间特征，并确定接受退伍军人事务部护理与非退伍军人事务部护理的退伍军人中与晚期血管外科手术相关的肢体并发症及医疗保健利用情况；2）描述接受血管修复个体所接受的预防服务及其相关结局；3）描述患有创伤性肢体血管损伤退伍军人报告的功能结局。
本研究将提供有关现役军人和患有多发伤/血管损伤、有持续发病和晚期截肢风险的退伍军人当前护理流程的关键信息。本研究结果将是退伍军人事务部和军事医疗机构的临床医生为这些损伤制定循证治疗和护理方法的第一步。它将确定需要康复医学、血管专科护理或远程医疗选项的领域，以便更好地规划、资源利用并改善从国防部到退伍军人事务部的护理过渡。
