Genitourinary injuries and extremity amputation in Operations Enduring Freedom and Iraqi Freedom: Early findings from the Trauma Outcomes and Urogenital Health (TOUGH) project

Nina S. Nnamani, Judson C. Janak, Steven J. Hudak, Jessica C. Rivera, Eluned A. Lewis, Douglas W. Soderdahl, Jean A. Orman

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

BACKGROUND: In Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF), genitourinary (GU) wounds have occurred in unprecedented numbers. Severe concomitant injuries, including extremity amputations, are common. The epidemiology of GU injury and extremity amputation in OEF/OIF has not been described. MATERIALS AND METHODS: The Department of Defense Trauma Registry was queried from October 2001 through August 2013 to identify all surviving US male service members with GU injuries sustained in OEF/OIF. Genitourinary injury was defined as sustaining one or more injuries to any organ or structure within the genitourinary and/or reproductive system(s) based on International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Injury severity was quantified based on Abbreviated Injury Scale scores and overall Injury Severity Scores. The incidence, nature, and severity of GU injuries and extremity amputations are described. RESULTS: Of the 1,367 service members with GU injury included in this analysis, 433 (31.7%) had one or more extremity amputations. MostGUinjurieswere to the external genitalia [scrotum (55.6%), testes (33.0%), penis (31.0%), and urethra (9.1%)] vs. the kidneys (21.1%). Those with amputation(s) had greater GU injury severity (Abbreviated Injury Scale score ≤ 3) than those without amputations (50.1% vs. 30.5%, respectively; p > 0.0001). Approximately 3.4% of male service members with GU injury had an upper extremity amputation only, 8.9% had both lower and upper extremity amputation(s), and 19.4% had lower extremity amputation(s) only. Of the 387 patients with GU injury and lower extremity amputations, 87 (22.5%) had amputations below the knee and 300 (77.5%) had amputation(s) at/above the knee. CONCLUSION: In OEF/OIF, concomitant GU injury and extremity amputation are common and have serious implications for health and quality of life. This wounding pattern presents new challenges to the militarymedical and research and development communities to prevent,mitigate, and treat these battlefield injuries. (J Trauma Acute Care Surg. 2016;81: S95-S99.

Original languageEnglish (US)
Pages (from-to)S95-S99
JournalJournal of Trauma and Acute Care Surgery
Volume81
Issue number5
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

Keywords

  • Extremity amputation
  • Genitourinary injury
  • Operation Enduring Freedom
  • Operation Iraqi Freedom
  • Urotrauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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