VA Vascular Injury Study (VAVIS): VA-DoD extremity injury outcomes collaboration

VA 血管损伤研究 (VAVIS)：VA-DoD 肢体损伤结果合作

• 批准号: 9145503
• 负责人: Mary Jo Pugh
• 金额: --
• 依托单位: SOUTH TEXAS VETERANS HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-01 至 2019-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9145503
• 关键词: Acute; Address; Affect; Afghanistan; Amputation; Antiplatelet Drugs; Area; Blood Vessels; Caring; Characteristics; Collaborations; Comorbidity; Complex; Data; Databases; Department of Defense; Development; Disabled Persons; Disease; Emergency Care; Epidemiology; Evidence based treatment; Freedom; Future; Geography; Goals; Health; Health Services Accessibility; Health Services Research; Individual; Injury; Iraq; Joints; Knowledge; Leg; Limb Salvage; Limb structure; Link; Long-Term Care; Longterm Follow-up; Medical; Medicare; Military Personnel; Monitor; Morbidity - disease rate; Musculoskeletal; Operative Surgical Procedures; Orthopedics; Outcome; Patients; Pattern; Patterns of Care; Peripheral Vascular Diseases; Physical Medicine; Population; Positioning Attribute; Prevalence; Preventive service; Procedures; Process; Prosthesis; Quality Indicator; Regimen; Registries; Reporting; Resources; Risk; Sampling; Standardization; Surveys; Techniques; Time; Trauma; Traumatic injury; Ultrasonography; Variant; Venous; Veterans; War; administrative database; arm; base; care outcomes; cohort; combat; demographics; functional decline; functional outcomes; functional status; health care service utilization; improved; injured; injury and repair; innovation; limb amputation; limb injury; medical specialties; operation; opioid therapy; repaired; screening; service member; telehealth; trauma care

The goal of this proposal is to understand the long-term outcomes and current processes of care for Veterans of Afghanistan and Iraq (Operations Enduring Freedom/ Iraqi Freedom/New Dawn; OEF/OIF) wars with polytrauma including vascular limb injuries, with a long-term goal of identifying best practices for this population. The high number of limb injuries among OEF/OIF veterans and their long- term, complex care requirements pose a significant challenge to the VA. Combat-related vascular injuries are present in 12% of this cohort, a rate 5 times higher than in prior wars, and extremity injuries comprise 50-60% of casualties. 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 Joint Theater Trauma Registry database (JTTR) was established to capture information on OEF/OIF injury demographics, mechanisms and management, from first assessment in the field through evacuation and return stateside. Our Department of Defense (DoD) collaborators have begun to explore outcomes for individuals with vascular injury and report that in a limited sample of patients, approximately 86% of those with initial vascular repair remain free of amputation 5 years post-injury. The outcomes after this period, and for the larger group of Veterans, have not been studied; long-term outcomes of the current process of care are not known. Current long-term follow-up for patients with traumatic vascular repair is based on best-practices for treatment of patients with peripheral vascular disease (PVD; e.g., antiplatelet/ statin therapy, annual duplex ultrasound). No best practices exist for traumatic vascular injury repair, so clinicians have little guidance about how treatment approaches for patients with PVD affect long-term outcomes in these wounded warriors. Moreover, access to care and geographic patterning of care have been associated with variation in outcomes for vascular procedures in patients with PVD. There is concern that outcomes after vascular repairs due to traumatic injuries (applying PVD standards of care) may also be affected by lack of access to the necessary expertise to monitor complications, but geospatial statistical techniques have not been extended to the study of patients with post-traumatic vascular repairs. To address this knowledge gap, we offer a VA-DoD team with expertise in vascular and orthopedic injuries, rehabilitation medicine, epidemiology, and health services research to conduct a study linking processes of care to long-term outcomes by addressing the following Aims: 1) Compare injury, demographic and geospatial characteristics of patients with initial in-theatre limb salvage (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. Our VA-DoD team and presence in San Antonio uniquely position us to identify Service Members/Veterans with extremity vascular repairs to determine long-term care and outcomes. This study will provide key information about the current process of care for OEF/ OIF 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 physiatry and vascular specialty care or telehealth options are needed allowing for better planning, resource utilization, and improved DoD-to-VA care transitions.

该提案的目标是了解护理的长期结果和当前流程 阿富汗和伊拉克退伍军人（持久自由行动/伊拉克自由/新黎明; OEF/OIF）战争多发伤（包括血管性肢体损伤），长期目标是识别 这一人群的最佳实践。OEF/OIF退伍军人中肢体受伤的人数很多， 长期以来，复杂的护理要求对VA构成了重大挑战。与战斗有关的血管损伤 在这个队列中占12%，比以前的战争高5倍，肢体损伤占50-60% 伤亡人数。改善内科和外科创伤护理，包括最初的手术室保肢 IILS方法（IILS）提高了生存率，减少了截肢，然而， 结果，如发病率，功能下降，以及使用电流挽救肢体的晚期截肢风险 护理过程尚未研究。建立了联合剧院创伤登记数据库（JTTR） 从第一次评估中获取有关OEF/OIF伤害人口统计数据、机制和管理的信息 撤离并返回美国我们的国防部合作者 开始探索血管损伤个体的结果，并报告在有限的患者样本中， 大约86%的初次血管修复的患者在损伤后5年内没有截肢。的 这一时期之后的结果，以及更大的退伍军人群体，尚未研究; 目前的护理过程尚不清楚。 目前对创伤性血管修复患者的长期随访是基于以下最佳实践： 治疗患有外周血管疾病（PVD;例如，抗血小板/他汀类药物治疗，每年二次 超声）。创伤性血管损伤修复没有最佳实践，因此临床医生在以下方面几乎没有指导： PVD患者的治疗方法如何影响这些受伤战士的长期结局。 此外，获得护理的机会和护理的地理模式与结果的差异有关 用于PVD患者的血管手术。有人担心，由于血管修复后的结果， 创伤性损伤（适用PVD护理标准）也可能受到缺乏必要的 监测并发症的专门知识，但地理空间统计技术尚未扩展到 创伤后血管修复的患者。为了解决这一知识差距，我们提供了一个VA-国防部团队， 血管和骨科损伤、康复医学、流行病学和卫生服务方面的专业知识 研究通过实现以下目标，进行一项将护理过程与长期结果联系起来的研究： 1)比较初次手术室保肢患者的损伤、人口统计学和地理空间特征 （IILS），并确定退伍军人中晚期血管手术相关肢体并发症和医疗保健利用 接受VA与非VA护理，2）描述患有血管疾病的个人接受的预防性服务 修复和相关结局，以及3）描述创伤性退伍军人中患者报告的功能结局 四肢血管损伤 我们的VA-国防部团队和在圣安东尼奥的存在使我们能够识别服务成员/退伍军人 与四肢血管修复，以确定长期护理和结果。这项研究将提供关键 关于OEF/ OIF退伍军人多发性创伤/血管损伤风险的当前护理过程的信息 持续发病和晚期截肢这项研究的结果将是临床医生在VA的第一步 和军事环境，以产生基于证据的治疗和护理方法，这些伤害。它将 确定需要物理治疗和血管专科护理或远程保健选择的领域，以便更好地 规划、资源利用和改善国防部到退伍军人管理局的护理过渡。