Nina S Nnamani1, Mary Jo Pugh2,3, Megan E Amuan4, Blessen C Eapen5,6, Steven J Hudak7,8, Michael A Liss3,9, Jean A Orman8,10. 1. US Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX. 2. Department of Epidemiology and Biostatistics, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX. 3. South Texas Veterans Health Care System, 7400 Merton Minter St., San Antonio, TX. 4. Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, 200 Springs Road, Bedford, MA. 5. Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, 7400 Merton Minter St., San Antonio, TX. 6. Department of Rehabilitation Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive San Antonio, TX. 7. Urology Clinic, Department of Surgery, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX. 8. Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD. 9. Department of Urology, University of Texas Health San Antonio, 7703 Floyd Curl Drive San Antonio, TX. 10. Joint Trauma System, 3698 Chambers Pass, JBSA Fort Sam Houston, San Antonio, TX.
Abstract
INTRODUCTION: In the recent conflicts, unprecedented numbers of US service personnel have survived with genitourinary (GU) injury, but few reports have focused on outcomes of these injuries. Outcomes of combat-related GU injury were investigated in wounded US male veterans of Operations Enduring/Iraqi Freedom and New Dawn receiving Veterans Health Administration (VHA) care. MATERIALS AND METHODS: Department of Defense Trauma Registry (DoDTR) data for male service members injured in theater were linked with VHA electronic health records (EHRs) for veterans who received VHA care at least once from October 2001 through September 2011. Abbreviated Injury Scale scores and International Classification of Diseases-9th Revision-Clinical Modification codes were used to identify GU injuries, severity, and outcomes. Wounded veterans with vs. without GU injury were compared. RESULTS: A total of 12,923 injured veterans were found in both databases; 591 (4.6%) had a GU injury diagnosis in the DoDTR; 18 (3.0% of 591) had a GU injury diagnosis in VHA EHRs. Of the 591 with GU injury, 179 (30.3%) had at least one severe GU injury. The prevalence of both urinary symptoms (6.3% vs. 3.1%; p < 0.0001) and sexual dysfunction (13.5% vs. 7.1%; p < 0.0001) was higher among those with vs. without GU injury, respectively. Traumatic brain injury prevalence was also higher (48.0 % vs. 40.0%; p < 0.0001); post-traumatic stress disorder prevalence was similar between the two groups (51.6% vs. 50.6%). CONCLUSION: We identified an opportunity to improve the diagnosis and coordination of care for veterans with GU injury. Routine screening and better documentation upon transfer from DoD to VHA care should be implemented to alert multi-specialty care teams to provide care for the urinary, sexual, fertility, and psychological health problems of these patients. Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2018.
INTRODUCTION: In the recent conflicts, unprecedented numbers of US service personnel have survived with genitourinary (GU) injury, but few reports have focused on outcomes of these injuries. Outcomes of combat-related GU injury were investigated in wounded US male veterans of Operations Enduring/Iraqi Freedom and New Dawn receiving Veterans Health Administration (VHA) care. MATERIALS AND METHODS: Department of Defense Trauma Registry (DoDTR) data for male service members injured in theater were linked with VHA electronic health records (EHRs) for veterans who received VHA care at least once from October 2001 through September 2011. Abbreviated Injury Scale scores and International Classification of Diseases-9th Revision-Clinical Modification codes were used to identify GU injuries, severity, and outcomes. Wounded veterans with vs. without GU injury were compared. RESULTS: A total of 12,923 injured veterans were found in both databases; 591 (4.6%) had a GU injury diagnosis in the DoDTR; 18 (3.0% of 591) had a GU injury diagnosis in VHA EHRs. Of the 591 with GU injury, 179 (30.3%) had at least one severe GU injury. The prevalence of both urinary symptoms (6.3% vs. 3.1%; p < 0.0001) and sexual dysfunction (13.5% vs. 7.1%; p < 0.0001) was higher among those with vs. without GU injury, respectively. Traumatic brain injury prevalence was also higher (48.0 % vs. 40.0%; p < 0.0001); post-traumatic stress disorder prevalence was similar between the two groups (51.6% vs. 50.6%). CONCLUSION: We identified an opportunity to improve the diagnosis and coordination of care for veterans with GU injury. Routine screening and better documentation upon transfer from DoD to VHA care should be implemented to alert multi-specialty care teams to provide care for the urinary, sexual, fertility, and psychological health problems of these patients. Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2018.
Entities:
Keywords:
genitourinary injury; psychological health conditions; sexual dysfunction; urinary symptoms; urotrauma
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