The VA vascular injury study: A glimpse at quality of care in Veterans with traumatic vascular injury repair.
The VA vascular injury study: A glimpse at quality of care in Veterans with traumatic vascular injury repair.
复制标题
退伍军人管理局血管损伤研究：对创伤性血管损伤修复退伍军人的护理质量一瞥。
DOI：
10.1016/j.injury.2022.04.002
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发表时间：
2022
期刊：
影响因子：
2.5
通讯作者：
Shireman,PaulaK
中科院分区：
文献类型：
--
作者：
Copeland,LaurelA;Pugh,MaryJo;Bollinger,MaryJ;Wang,Chen-Pin;Amuan,MeganE;Rivera,JessicaC;Shireman,PaulaK
ObjectiveThe high number of limb injuries among Post-9/11 Veterans and their long-term care pose significant challenges to clinicians. Current follow-up for extremity arterial vascular injury (EVI) is based on guideline-concordant care for treatment of peripheral vascular disease (GCC-PVD), including anticoagulant/antiplatelet or statin therapy and duplex ultrasound. No best practices exist for arterial EVI. Our goal was to determine correlates of GCC-PVD and other care among Post-9/11 Veterans with combat-related arterial EVI.Materials and methodsWe identified Post-9/11 Veterans with arterial EVI who underwent initial limb salvage repair or ligation (e.g., for single-vessel injury) attempt per DoD Trauma Registry validated by chart abstraction. Veterans Health Administration (VHA) data characterized the cohort in the first five years of VHA care. Models predicted (a) GCC-PVD, (b) pain clinic use, (c) mental/behavioral health care, (d) long-term opioid use, and (e) time to complication, controlling for injury severity and type, mental health parameters, and demographics.ResultsThe 490-Veteran cohort with validated arterial injury was 77% White averaging 25.2 years at injury (range: 18–56). Mechanism of injury was primarily explosive (63%). Veterans had Injury Severity Scores classified as mild (60%), moderate (25%) and severe (15%). Approximately 25% received at least one component of VHA GCC-PVD including 8% arterial ultrasounds, 5% statins, and 11% anticoagulants/antiplatelets; 77% had mental/behavioral healthcare. GCC-PVD, as well as PTSD and substance use disorders, were associated with receipt of mental/behavioral health care. Complications affected 46% of the cohort and were more common among those prescribed 90+ days of opioids or receiving GCC-PVD.ConclusionDespite injury severity (40% moderate/severe), only 25% of cohort patients received VHA GCC-PVD, and nearly half had complications from their arterial injury. Receiving GCC-PVD appeared to potentiate receiving care for mental and behavioral disorders.ImpactThe treatment gap in Veterans with arterial EVI may be due to lack of appropriate guidelines, lack of vascular specialists in VHA or accessing care outside the VHA. Focused study of care options and their outcomes will help define optimal care processes for combat Veterans with arterial EVI.
