Abstract
Introduction
Improvised explosive devices (IEDs) are the defining mechanism of injury during Operation
Enduring Freedom. This is a retrospective analysis of initial management for IED blast
injuries presenting with bilateral, traumatic, lower-extremity (LE) amputations with
and without pelvic and perineal involvement.
Methods
A database of trauma admissions presenting to a North Atlantic Treaty Organization
(NATO) Role 3 combat hospital in southern Afghanistan over a 7-month period was created
to evaluate the care of this particular injury pattern. Patients were included if
they were received from point of injury with at least bilateral traumatic LE amputations
and had vital signs with initial resuscitation efforts.
Results
Thirty-two presented with double LE amputations (36%) and nine with triple amputations
(10%). After excluding 10 patients who failed to meet the inclusion criteria, 22 patients
were analysed. The mean age was 29 years, and the average ISS and admission haemoglobin
were 22 and 11.3 mg l−1, respectively. Patients received an average of 54 units of blood products and underwent
1.6 operations with a mean operative time of 142.5 min. The pattern of injury was associated with an increase in the total blood products
required for resuscitation (pelvis n = 12, p = 0.028, gastrointestinal tract (GI) n = 14, p = 0.02, perineal n = 15, p = 0.036). There was no relationship between ISS or admission haemoglobin and the need
for massive transfusion. Low Glasgow Coma Scale (GCS) was associated with increased
30-day mortality. Hollow viscus injury and operative hemipelvectomy were also associated
with mortality.
Conclusions
Early 30-day follow-up demonstrated that IED injuries with bilateral LE amputations
with and without pelvic and perineal involvement are survivable injuries. Standard
measures of injury and predictors of survival bore little relationship to observed
outcomes and may need to be re-evaluated. Long-term follow-up is needed to assess
the extent of functional recovery and overall morbidity and mortality.
Keywords
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Article info
Publication history
Accepted:
June 27,
2012
Identification
Copyright
Published by Elsevier Inc.
