Initial predictors associated with outcome in injured multiple traumatic limb amputations: A Kandahar-based combat hospital experience

Rodd J. Benfield, Christiaan N. Mamczak, Kim Chi T. Vo, Tricia Smith, Lisa Osborne Smith, Forrest R. Sheppard, Eric A. Elster

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Introduction: Improvised explosive devices (IEDs) are the defining mechanism of injury during Operation Enduring Freedom. This is a retrospective analysis of initial management for IED blast injuries presenting with bilateral, traumatic, lower-extremity (LE) amputations with and without pelvic and perineal involvement. Methods: A database of trauma admissions presenting to a North Atlantic Treaty Organization (NATO) Role 3 combat hospital in southern Afghanistan over a 7-month period was created to evaluate the care of this particular injury pattern. Patients were included if they were received from point of injury with at least bilateral traumatic LE amputations and had vital signs with initial resuscitation efforts. Results: Thirty-two presented with double LE amputations (36%) and nine with triple amputations (10%). After excluding 10 patients who failed to meet the inclusion criteria, 22 patients were analysed. The mean age was 29 years, and the average ISS and admission haemoglobin were 22 and 11.3 mg l-1, respectively. Patients received an average of 54 units of blood products and underwent 1.6 operations with a mean operative time of 142.5 min. The pattern of injury was associated with an increase in the total blood products required for resuscitation (pelvis n = 12, p = 0.028, gastrointestinal tract (GI) n = 14, p = 0.02, perineal n = 15, p = 0.036). There was no relationship between ISS or admission haemoglobin and the need for massive transfusion. Low Glasgow Coma Scale (GCS) was associated with increased 30-day mortality. Hollow viscus injury and operative hemipelvectomy were also associated with mortality. Conclusions: Early 30-day follow-up demonstrated that IED injuries with bilateral LE amputations with and without pelvic and perineal involvement are survivable injuries. Standard measures of injury and predictors of survival bore little relationship to observed outcomes and may need to be re-evaluated. Long-term follow-up is needed to assess the extent of functional recovery and overall morbidity and mortality.

Original languageEnglish (US)
Pages (from-to)1753-1758
Number of pages6
JournalInjury
Volume43
Issue number10
DOIs
StatePublished - Oct 1 2012
Externally publishedYes

Fingerprint

Traumatic Amputation
Extremities
Amputation
Wounds and Injuries
Lower Extremity
Resuscitation
Equipment and Supplies
Mortality
Hemoglobins
Hemipelvectomy
Afghan Campaign 2001-
Blast Injuries
Afghanistan
International Cooperation
Glasgow Coma Scale
Viscera
Vital Signs
Operative Time
Pelvis
Gastrointestinal Tract

Keywords

  • Kandahar trauma experience
  • Medical trauma
  • Traumatic limb amputation
  • War trauma

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

Cite this

Initial predictors associated with outcome in injured multiple traumatic limb amputations : A Kandahar-based combat hospital experience. / Benfield, Rodd J.; Mamczak, Christiaan N.; Vo, Kim Chi T.; Smith, Tricia; Osborne Smith, Lisa; Sheppard, Forrest R.; Elster, Eric A.

In: Injury, Vol. 43, No. 10, 01.10.2012, p. 1753-1758.

Research output: Contribution to journalArticle

Benfield, Rodd J. ; Mamczak, Christiaan N. ; Vo, Kim Chi T. ; Smith, Tricia ; Osborne Smith, Lisa ; Sheppard, Forrest R. ; Elster, Eric A. / Initial predictors associated with outcome in injured multiple traumatic limb amputations : A Kandahar-based combat hospital experience. In: Injury. 2012 ; Vol. 43, No. 10. pp. 1753-1758.
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AU - Vo, Kim Chi T.

AU - Smith, Tricia

AU - Osborne Smith, Lisa

AU - Sheppard, Forrest R.

AU - Elster, Eric A.

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N2 - Introduction: Improvised explosive devices (IEDs) are the defining mechanism of injury during Operation Enduring Freedom. This is a retrospective analysis of initial management for IED blast injuries presenting with bilateral, traumatic, lower-extremity (LE) amputations with and without pelvic and perineal involvement. Methods: A database of trauma admissions presenting to a North Atlantic Treaty Organization (NATO) Role 3 combat hospital in southern Afghanistan over a 7-month period was created to evaluate the care of this particular injury pattern. Patients were included if they were received from point of injury with at least bilateral traumatic LE amputations and had vital signs with initial resuscitation efforts. Results: Thirty-two presented with double LE amputations (36%) and nine with triple amputations (10%). After excluding 10 patients who failed to meet the inclusion criteria, 22 patients were analysed. The mean age was 29 years, and the average ISS and admission haemoglobin were 22 and 11.3 mg l-1, respectively. Patients received an average of 54 units of blood products and underwent 1.6 operations with a mean operative time of 142.5 min. The pattern of injury was associated with an increase in the total blood products required for resuscitation (pelvis n = 12, p = 0.028, gastrointestinal tract (GI) n = 14, p = 0.02, perineal n = 15, p = 0.036). There was no relationship between ISS or admission haemoglobin and the need for massive transfusion. Low Glasgow Coma Scale (GCS) was associated with increased 30-day mortality. Hollow viscus injury and operative hemipelvectomy were also associated with mortality. Conclusions: Early 30-day follow-up demonstrated that IED injuries with bilateral LE amputations with and without pelvic and perineal involvement are survivable injuries. Standard measures of injury and predictors of survival bore little relationship to observed outcomes and may need to be re-evaluated. Long-term follow-up is needed to assess the extent of functional recovery and overall morbidity and mortality.

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