A Data-Driven Method to Discriminate Limb Salvage from Other Combat-Related Extremity Trauma

Stephen M Goldman^{1

2}, Susan L Eskridge^{3

4}, Sarah R Franco^{1

2}, Jason M Souza^{2

5}, Scott M Tintle^{2

6}, Thomas C Dowd⁷, Joseph Alderete⁷, Benjamin K Potter^{2

6}, Christopher L Dearth^{1

2}

Affiliations

¹ DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20889, USA.
² Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD 20814, USA.
³ Leidos, Reston, VA 20190, USA.
⁴ Naval Health Research Center, San Diego, CA 92152, USA.
⁵ Department of Plastic and Reconstructive Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA.
⁶ Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA.
⁷ Department of Orthopaedic Surgery, San Antonio Military Medical Center, Houston, TX 78234, USA.

PMID: 37835001
PMCID: PMC10573244
DOI: 10.3390/jcm12196357

A Data-Driven Method to Discriminate Limb Salvage from Other Combat-Related Extremity Trauma

Stephen M Goldman et al. J Clin Med. 2023.

. 2023 Oct 4;12(19):6357.

doi: 10.3390/jcm12196357.

Authors

Affiliations

¹ DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20889, USA.
² Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD 20814, USA.
³ Leidos, Reston, VA 20190, USA.
⁴ Naval Health Research Center, San Diego, CA 92152, USA.
⁵ Department of Plastic and Reconstructive Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA.
⁶ Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA.
⁷ Department of Orthopaedic Surgery, San Antonio Military Medical Center, Houston, TX 78234, USA.

PMID: 37835001
PMCID: PMC10573244
DOI: 10.3390/jcm12196357

Abstract

Introduction: The aim of this study was to address and enhance our ability to study the clinical outcome of limb salvage (LS), a commonly referenced but ill-defined clinical care pathway, by developing a data-driven approach for the identification of LS cases using existing medical code data to identify characteristic diagnoses and procedures, and to use that information to describe a cohort of US Service members (SMs) for further study.

Methods: Diagnosis code families and inpatient procedure codes were compiled and analyzed to identify medical codes that are disparately associated with a LS surrogate population of SMs who underwent secondary amputation within a broader cohort of 3390 SMs with lower extremity trauma (AIS > 1). Subsequently, the identified codes were used to define a cohort of all SMs who underwent lower extremity LS which was compared with the opinion of a panel of military trauma surgeons.

Results: The data-driven approach identified a population of n = 2018 SMs who underwent LS, representing 59.5% of the combat-related lower extremity (LE) trauma population. Validation analysis revealed 70% agreement between the data-driven approach and gold standard SME panel for the test cases studied. The Kappa statistic (κ = 0.55) indicates a moderate agreement between the data-driven approach and the expert opinion of the SME panel. The sensitivity and specificity were identified as 55.6% (expert range of 51.8-66.7%) and 87% (expert range of 73.9-91.3%), respectively.

Conclusions: This approach for identifying LS cases can be utilized to enable future high-throughput retrospective analyses for studying both short- and long-term outcomes of this underserved patient population.

Keywords: Abbreviated Injury Scale; amputation; military medicine; musculoskeletal injuries; wound and injuries.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
Graphical representation of the various sub-groups witin the population of Service members with combat-related extremity trauma, including those which are characterized as limb salvage.

See this image and copyright information in PMC

References

1. Cross J.D., Ficke J.R., Hsu J.R., Masini B.D., Wenke J.C. Battlefield orthopaedic injuries cause the majority of long-term disabilities. J. Am. Acad. Orthop. Surg. 2011;19((Suppl. S1)):S1–S7. doi: 10.5435/00124635-201102001-00002. - DOI - PubMed
1. Dougherty A.L., Mohrle C.R., Galarneau M.R., Woodruff S.I., Dye J.L., Quinn K.H. Battlefield extremity injuries in Operation Iraqi Freedom. Injury. 2009;40:772–777. doi: 10.1016/j.injury.2009.02.014. - DOI - PubMed
1. Goldberg M.S. Casualty Rates of US Military Personnel During the Wars in Iraq and Afghanistan. Def. Peace Econ. 2018;29:44–61. doi: 10.1080/10242694.2015.1129816. - DOI
1. Goldberg M.S. Death and Injury Rates of U.S. Military Personnel in Iraq. Mil. Med. 2010;175:220–226. doi: 10.7205/MILMED-D-09-00130. - DOI - PubMed
1. Major Extremity Trauma Research Consortium Outcomes Following Severe Distal Tibial, Ankle, and/or Mid/Hindfoot Trauma: Comparison of Limb Salvage and Transtibial Amputation (OUTLET) J. Bone Jt. Surg. Am. 2021;103:1588–1597. doi: 10.2106/JBJS.20.01320. - DOI - PubMed

Grants and funding

HU00012020038/DoD-VA Extremity Trauma and Amputation Center of Excellence

LinkOut - more resources

Full Text Sources

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

A Data-Driven Method to Discriminate Limb Salvage from Other Combat-Related Extremity Trauma

Affiliations

A Data-Driven Method to Discriminate Limb Salvage from Other Combat-Related Extremity Trauma

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources