Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Mar 1;184(Suppl 1):83-91.
doi: 10.1093/milmed/usy336.

Combat-Related Extremity Wounds: Injury Factors Predicting Early Onset Infections

Laveta Stewart  1   2 , Faraz Shaikh  1   2 , William Bradley  1   2   3 , Dan Lu  1   2 , Dana M Blyth  3 , Joseph L Petfield  4 , Timothy J Whitman  5 , Margot Krauss  6 , Lauren Greenberg  6 , David R Tribble  1
Affiliations

Combat-Related Extremity Wounds: Injury Factors Predicting Early Onset Infections

Laveta Stewart et al. Mil Med. .

Abstract

We examined risk factors for combat-related extremity wound infections (CEWI) among U.S. military patients injured in Iraq and Afghanistan (2009-2012). Patients with ≥1 combat-related, open extremity wound admitted to a participating U.S. hospital (≤7 days postinjury) were retrospectively assessed. The population was classified based upon most severe injury (amputation, open fracture without amputation, or open soft-tissue injury defined as non-fracture/non-amputation wounds). Among 1271 eligible patients, 395 (31%) patients had ≥1 amputation, 457 (36%) had open fractures, and 419 (33%) had open soft-tissue wounds as their most severe injury, respectively. Among patients with traumatic amputations, 100 (47%) developed a CEWI compared to 66 (14%) and 12 (3%) patients with open fractures and open soft-tissue wounds, respectively. In a Cox proportional hazard analysis restricted to CEWIs ≤30 days postinjury among the traumatic amputation and open fracture groups, sustaining an amputation (hazard ratio: 1.79; 95% confidence interval: 1.25-2.56), blood transfusion ≤24 hours postinjury, improvised explosive device blast, first documented shock index ≥0.80, and >4 injury sites were independently associated with CEWI risk. The presence of a non-extremity infection at least 4 days prior to a CEWI diagnosis was associated with lower CEWI risk, suggesting impact of recent exposure to directed antimicrobial therapy. Further assessment of early clinical management will help to elucidate risk factor contribution. The wound classification system provides a comprehensive approach in assessment of injury and clinical factors for the risk and outcomes of an extremity wound infection.

Keywords: combat-related; extremity wounds; polytrauma; trauma infections; wound infections.

PubMed Disclaimer

Figures

FIGURE 1.
FIGURE 1.
Study population derivation of patients with combat-related open extremity wounds, by wound type and infectious outcome. aThe population for the risk factor model excluded early surgical amputations and only considered infections diagnosed within 30 days postinjury.
FIGURE 2.
FIGURE 2.
Kaplan–Meier survival plot of time to CEWI diagnosis, stratified by number of OR visits. Plots are censored to time of first CEWI or 30 days postinjury. Log-rank Chi-square: 169.17 (p < 0.0001); Wilcoxon Chi-square: 209.72 (p < 0.0001).
See this image and copyright information in PMC

References

    1. Owens BD, Kragh JF Jr, Macaitis J, Svoboda SJ, Wenke JC: Characterization of extremity wounds in Operation Iraqi Freedom and Operation Enduring Freedom. J Orthop Trauma 2007; 21(4): 254–7. - PubMed
    1. Belmont PJ Jr., Goodman GP, Zacchilli M, Posner M, Evans C, Owens BD: Incidence and epidemiology of combat injuries sustained during “the surge” portion of operation Iraqi Freedom by a U.S. Army brigade combat team. J Trauma 2010; 68(1): 204–10. - PubMed
    1. Belmont PJ, Owens BD, Schoenfeld AJ: Musculoskeletal injuries in Iraq and Afghanistan: epidemiology and outcomes following a decade of war. J Am Acad Orthop Surg 2016; 24(6): 341–8. - PubMed
    1. Andersen CR, D’Alleyrand MP, Swiontkowski MF, Ficke JR: Extremity war injuries IVSM: extremity war injuries VIII: sequelae of combat injuries. J Am Acad Orthop Surg 2014; 22(1): 57–62. - PubMed
    1. Ficke JR, Eastridge BJ, Butler F, et al. : Dismounted complex blast injury report of the Army Dismounted Complex Blast Injury Task Force. J Trauma Acute Care Surg 2012; 73(6 Suppl 5): S520–34.

Publication types