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Characteristics and rehabilitation outcomes among patients with blast and other injuries sustained during the Global War on Terror |
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| Authors: | Sayer Nina A Chiros Christine E Sigford Barbara Scott Steven Clothier Barbara Pickett Treven Lew Henry L |
| Affiliation: | a Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, MN b Department of Medicine, University of Minnesota, Twin Cities Campus, Minneapolis, MN c Department of Psychology, University of Minnesota, Twin Cities Campus, Minneapolis, MN d Physical Medicine and Rehabilitation, VA Medical Center, Minneapolis, MN e Physical Medicine and Rehabilitation, James A. Haley VA Medical Center, Tampa, FL f University of South Florida College of Medicine, Tampa, FL g Defense and Veterans Brain Injury Center and McGuire VA Medical Center, Richmond, VA h Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, VA i Defense and Veterans Brain Injury Center and VA Medical Center, Palo Alto, CA j School of Medicine, Stanford University, Stanford, CA. |
| Abstract: | Sayer NA, Chiros CE, Sigford B, Scott S, Clothier B, Pickett T, Lew HL. Characteristics and rehabilitation outcomes among patients with blast and other injuries sustained during the Global War on Terror. ObjectiveTo describe characteristics and rehabilitation outcomes among patients who received inpatient rehabilitation for blast and other injuries sustained in Iraq and Afghanistan during the Global War on Terror.DesignObservational study based on chart review and Department of Veterans Affairs (VA) administrative data.SettingThe 4 VA polytrauma rehabilitation centers (PRCs).ParticipantsService members (N=188) admitted to a PRC during the first 4 years of the Global War on Terror for injuries sustained during Operation Iraqi Freedom or Operation Enduring Freedom.InterventionMultidisciplinary comprehensive rehabilitation program.Main Outcomes MeasuresCognitive and motor FIM instrument gain scores and length of stay (LOS).ResultsMost war-injured patients had traumatic brain injury, injuries to several other body systems and organs, and associated pain. Fifty-six percent had blast-related injuries, and the pattern of injuries was unique among those with injuries secondary to blasts. Soft tissue, eye, oral and maxillofacial, otologic, penetrating brain injuries, symptoms of post-traumatic stress disorder, and auditory impairments were more common in blast-injured patients than in those with war injuries of other etiologies. The mechanism of the injury did not predict functional outcomes. LOS was variable, particularly for those with blast injuries. Patients with low levels of independence at admissions made the most progress but remained more dependent at discharge compared with other PRC patients. The rate of gain was slower in this low-functioning group.ConclusionsBlasts produce a unique constellation of injuries but do not make a unique contribution to functional gain scores. Findings underscore the need for assessment and treatment of pain and mental health problems among patients with polytrauma and blast-related injuries. Patients with polytrauma have lifelong needs, and future research should examine needs over time after community re-entry. |
| Keywords: | Brain injuries Length of stay Outcome assessment (health care) Rehabilitation |
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