Infectious Complications After Deployment Trauma: Following Wounded US Military Personnel Into Veterans Affairs Care

Abstract

Background: Infectious complications related to deployment trauma significantly contribute to the morbidity and mortality of wounded service members. The Trauma Infectious Disease Outcomes Study (TIDOS) collects data on US military personnel injured in Iraq and Afghanistan in an observational cohort study of infectious complications. Patients enrolled in TIDOS may also consent to follow-up through the Department of Veterans Affairs (VA). We present data from the first 337 TIDOS enrollees to receive VA healthcare.

Methods: Data were collected from the Department of Defense (DoD) Trauma Registry, TIDOS infectious disease module, DoD and VA electronic medical records, and telephone interview. Cox proportional hazard analysis was performed to identify predictors of post-discharge infections related to deployment trauma.

Results: Among the first 337 TIDOS enrollees who entered VA healthcare, 111 (33%) had 244 trauma-related infections during their initial trauma hospitalization (2.1 infections per 100 person-days). Following initial discharge, 127 (38%) enrollees had 239 trauma-related infections (170 during DoD follow-up and 69 during VA time). Skin and soft-tissue infections and osteomyelitis were predominant during and after the initial trauma hospitalization. In a multivariate model, a shorter time to development of a new infection following discharge was independently associated with injury severity score ≥10 and occurrence of ≥1 inpatient infection during initial trauma hospitalization.

Conclusions: Incident infections related to deployment trauma continue well after initial hospital discharge and into VA healthcare. Overall, 38% of enrolled patients developed a new trauma-related infection after their initial hospital discharge, with 29% occurring after the patient left military service.

Figure 1.

Flowchart of patients following admission to Landstuhl Regional Medical Center through enrollment in the Veterans Affairs cohort of the Trauma Infectious Disease Outcomes Study, with inclusion of infection outcome information. Abbreviations: LRMC, Landstuhl Regional Medical Center; TIDOS, Trauma Infectious Disease Outcomes Study; VA, Veterans Affairs.

Figure 2.

Time to new infection related to traumatic injury following initial trauma hospital discharge for the most common infections (skin and soft-tissue infections, osteomyelitis, urinary tract infections). Abbreviations: OSTEO, osteomyelitis; SSTI, skin and soft-tissue infection; UTI, urinary tract infection.

Figure 3.

Kaplan-Meier survival plots (with 95% Hall-Wellner bands) of time to new infection following initial trauma hospital discharge. A, Plot stratified by injury severity score. Log-rank χ², 16.8 (P < .001); Wilcoxon χ², 16.2 (P = .001). B, Plot stratified by volume of blood transfusion within 24 hours of injury. Log-rank χ², 11.2 (P = .011); Wilcoxon χ², 7.4 (P = .060). C, Plot stratified by length of inpatient hospitalization. Log-rank χ², 18.7 (P < .001); Wilcoxon χ², 15.7 (P = .001). D, Plot stratified by number of inpatient infections. Log-rank χ², 21.8 (P < .001); Wilcoxon χ², 18.2 (P < .001).