Venous thromboembolism during combat operations: A 10-y review

Tara N. Hutchison, Chad A. Krueger, John S. Berry, James K. Aden, Stephen M. Cohn, Christopher E. White

Research output: Contribution to journalArticle

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Abstract

Background This article examines the incidence of venous thromboembolism (VTE) in combat wounded, identifies risk factors for pulmonary embolism (PE), and compares the rate of PE in combat with previously reported civilian data. Methods A retrospective review was performed of all U.S. military combat casualties in Operation Enduring Freedom and Operation Iraqi Freedom with a VTE recorded in the Department of Defense Trauma Registry from September 2001 to July 2011. The Military Amputation Database of all U.S. military amputations during the same 10-y period was also reviewed. Demographic data, injury characteristics, and outcomes were evaluated. Results Among 26,634 subjects, 587 (2.2%) had a VTE. This number included 270 subjects (1.0%) with deep venous thrombosis (DVT), 223 (0.8%) with PE, and 94 (0.4%) with both DVT and PE. Lower extremity amputation was independently associated with PE (odds ratio [OR], 1.70; 95% confidence interval [CI], 1.07-2.69). A total of 1003 subjects suffered a lower extremity amputation, with 174 (17%) having a VTE. Of these, 75 subjects (7.5%) were having DVT, 70 (7.0%) were having PE, and 29 (2.9%) were found to have both a DVT and a PE. Risk factors found to be independently associated with VTE in amputees were multiple amputations (OR, 2; 95% CI, 1.35-3.42) and above the knee amputation (OR, 2.11; 95% CI, 1.3-3.32). Conclusions Combat wounded are at a high risk for thromboembolic complications with the highest risk associated with multiple or above the knee amputations.

Original languageEnglish (US)
Pages (from-to)625-630
Number of pages6
JournalJournal of Surgical Research
Volume187
Issue number2
DOIs
StatePublished - Apr 2014

Fingerprint

antineoplaston A10
Venous Thromboembolism
Pulmonary Embolism
Amputation
Venous Thrombosis
2003-2011 Iraq War
Odds Ratio
Confidence Intervals
Lower Extremity
Knee
Afghan Campaign 2001-
Amputees
Wounds and Injuries
Registries
Demography
Databases
Incidence

Keywords

  • Amputation
  • Combat
  • Deep venous thrombosis
  • Pulmonary embolism
  • Trauma
  • Venous thromboembolism
  • War

ASJC Scopus subject areas

  • Surgery

Cite this

Hutchison, T. N., Krueger, C. A., Berry, J. S., Aden, J. K., Cohn, S. M., & White, C. E. (2014). Venous thromboembolism during combat operations: A 10-y review. Journal of Surgical Research, 187(2), 625-630. https://doi.org/10.1016/j.jss.2013.11.008

Venous thromboembolism during combat operations : A 10-y review. / Hutchison, Tara N.; Krueger, Chad A.; Berry, John S.; Aden, James K.; Cohn, Stephen M.; White, Christopher E.

In: Journal of Surgical Research, Vol. 187, No. 2, 04.2014, p. 625-630.

Research output: Contribution to journalArticle

Hutchison, TN, Krueger, CA, Berry, JS, Aden, JK, Cohn, SM & White, CE 2014, 'Venous thromboembolism during combat operations: A 10-y review', Journal of Surgical Research, vol. 187, no. 2, pp. 625-630. https://doi.org/10.1016/j.jss.2013.11.008
Hutchison TN, Krueger CA, Berry JS, Aden JK, Cohn SM, White CE. Venous thromboembolism during combat operations: A 10-y review. Journal of Surgical Research. 2014 Apr;187(2):625-630. https://doi.org/10.1016/j.jss.2013.11.008
Hutchison, Tara N. ; Krueger, Chad A. ; Berry, John S. ; Aden, James K. ; Cohn, Stephen M. ; White, Christopher E. / Venous thromboembolism during combat operations : A 10-y review. In: Journal of Surgical Research. 2014 ; Vol. 187, No. 2. pp. 625-630.
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title = "Venous thromboembolism during combat operations: A 10-y review",
abstract = "Background This article examines the incidence of venous thromboembolism (VTE) in combat wounded, identifies risk factors for pulmonary embolism (PE), and compares the rate of PE in combat with previously reported civilian data. Methods A retrospective review was performed of all U.S. military combat casualties in Operation Enduring Freedom and Operation Iraqi Freedom with a VTE recorded in the Department of Defense Trauma Registry from September 2001 to July 2011. The Military Amputation Database of all U.S. military amputations during the same 10-y period was also reviewed. Demographic data, injury characteristics, and outcomes were evaluated. Results Among 26,634 subjects, 587 (2.2{\%}) had a VTE. This number included 270 subjects (1.0{\%}) with deep venous thrombosis (DVT), 223 (0.8{\%}) with PE, and 94 (0.4{\%}) with both DVT and PE. Lower extremity amputation was independently associated with PE (odds ratio [OR], 1.70; 95{\%} confidence interval [CI], 1.07-2.69). A total of 1003 subjects suffered a lower extremity amputation, with 174 (17{\%}) having a VTE. Of these, 75 subjects (7.5{\%}) were having DVT, 70 (7.0{\%}) were having PE, and 29 (2.9{\%}) were found to have both a DVT and a PE. Risk factors found to be independently associated with VTE in amputees were multiple amputations (OR, 2; 95{\%} CI, 1.35-3.42) and above the knee amputation (OR, 2.11; 95{\%} CI, 1.3-3.32). Conclusions Combat wounded are at a high risk for thromboembolic complications with the highest risk associated with multiple or above the knee amputations.",
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N2 - Background This article examines the incidence of venous thromboembolism (VTE) in combat wounded, identifies risk factors for pulmonary embolism (PE), and compares the rate of PE in combat with previously reported civilian data. Methods A retrospective review was performed of all U.S. military combat casualties in Operation Enduring Freedom and Operation Iraqi Freedom with a VTE recorded in the Department of Defense Trauma Registry from September 2001 to July 2011. The Military Amputation Database of all U.S. military amputations during the same 10-y period was also reviewed. Demographic data, injury characteristics, and outcomes were evaluated. Results Among 26,634 subjects, 587 (2.2%) had a VTE. This number included 270 subjects (1.0%) with deep venous thrombosis (DVT), 223 (0.8%) with PE, and 94 (0.4%) with both DVT and PE. Lower extremity amputation was independently associated with PE (odds ratio [OR], 1.70; 95% confidence interval [CI], 1.07-2.69). A total of 1003 subjects suffered a lower extremity amputation, with 174 (17%) having a VTE. Of these, 75 subjects (7.5%) were having DVT, 70 (7.0%) were having PE, and 29 (2.9%) were found to have both a DVT and a PE. Risk factors found to be independently associated with VTE in amputees were multiple amputations (OR, 2; 95% CI, 1.35-3.42) and above the knee amputation (OR, 2.11; 95% CI, 1.3-3.32). Conclusions Combat wounded are at a high risk for thromboembolic complications with the highest risk associated with multiple or above the knee amputations.

AB - Background This article examines the incidence of venous thromboembolism (VTE) in combat wounded, identifies risk factors for pulmonary embolism (PE), and compares the rate of PE in combat with previously reported civilian data. Methods A retrospective review was performed of all U.S. military combat casualties in Operation Enduring Freedom and Operation Iraqi Freedom with a VTE recorded in the Department of Defense Trauma Registry from September 2001 to July 2011. The Military Amputation Database of all U.S. military amputations during the same 10-y period was also reviewed. Demographic data, injury characteristics, and outcomes were evaluated. Results Among 26,634 subjects, 587 (2.2%) had a VTE. This number included 270 subjects (1.0%) with deep venous thrombosis (DVT), 223 (0.8%) with PE, and 94 (0.4%) with both DVT and PE. Lower extremity amputation was independently associated with PE (odds ratio [OR], 1.70; 95% confidence interval [CI], 1.07-2.69). A total of 1003 subjects suffered a lower extremity amputation, with 174 (17%) having a VTE. Of these, 75 subjects (7.5%) were having DVT, 70 (7.0%) were having PE, and 29 (2.9%) were found to have both a DVT and a PE. Risk factors found to be independently associated with VTE in amputees were multiple amputations (OR, 2; 95% CI, 1.35-3.42) and above the knee amputation (OR, 2.11; 95% CI, 1.3-3.32). Conclusions Combat wounded are at a high risk for thromboembolic complications with the highest risk associated with multiple or above the knee amputations.

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KW - Deep venous thrombosis

KW - Pulmonary embolism

KW - Trauma

KW - Venous thromboembolism

KW - War

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