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

Project: Research project

Description

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.
StatusFinished
Effective start/end date4/1/153/31/18

Funding

  • National Institutes of Health

Fingerprint

Vascular System Injuries
Extremities
Blood Vessels
Wounds and Injuries
Veterans
Amputation
Long-Term Care
Multiple Trauma
Practice Guidelines
Afghan Campaign 2001-
Patient Acceptance of Health Care
Demography
Morbidity
Afghanistan
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Patient Transfer
Physical and Rehabilitation Medicine
Iraq
Limb Salvage
Peripheral Vascular Diseases

ASJC

  • Medicine(all)