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BACKGROUND/RATIONALE:
Project Background: While recently funded HSR&D studies have begun to explore PTSD, polytrauma, and blast-related injury outcomes in OEF/OIF veterans, none specifically focus on those with burn injuries. Burn patients face unique challenges and often require extensive treatment and rehabilitation. With advances in body armor, combat burns more frequently injure the face and hands, compared to the upper arms, chest, and thighs in civilian burns. In addition, OEF/OIF combat injuries often involve polytrauma, i.e., combinations of burn, blast injury, and traumatic brain injury. The joint impact of such injuries on long-term function and re-integration into society is unknown. The USAISR Burn Center is the sole referral site for all burn injury in all military services and the regional referral center for civilian burn injuries in South Texas. BAMC, the Army's second largest medical center, is the referral center for the Great Plains Regional Medical Command. The co-location of BAMC, USAISR, and the VERDICT REAP provides a unique and pivotal opportunity for joint collaboration on this important topic between Veterans Affairs Health Services Research and Development (VA HSR&D) and the Department of Defense (DoD).
OBJECTIVE(S):
Project Objectives: Building on DoD and VA trauma, clinical, and administrative databases and partnering with planned DoD short-term follow-up studies, we propose to systematically assess long-term functioning at discharge, 1, 2, 3, and 4 years in OEF/OIF combat burns plus two comparison cohorts: OEF/OIF survivors of non-burn combat trauma and survivors of civilian burns. We expect that survivors of combat burns will have worse long-term functioning compared to those surviving combat non-burn trauma and civilian burns.
METHODS:
Project Methods: We will use a prospective cohort study design utilizing data from USAISR/BAMC databases and patient surveys to compare the rate of improvement in functioning for three cohorts (survivors of combat burn, combat non-burn trauma, and civilian burns) discharged from the USAISR Burn Center or the BAMC Trauma Center after January 2007. The prospective study will build on DoD studies that will assess functional outcomes of combat and civilian burn patients at discharge, and at 3,6,12, and 18 months follow-up. We will continue follow-up at 2, 3, and 4 years and enroll a third cohort (combat non-burn trauma) at discharge with follow-ups at 1, 2, 3 and 4 years. The study and hypothesis testing will be guided by the Disablement Process Model, a generalized sociomedical framework for investigating the complex pathways from disease or injury to rehabilitation, disability, and recovery. Our 4 primary outcomes will be activities of daily living, instrumental activities of daily living, work status, and community integration. We will control for three groups of variables: 1) sociodemographics; 2) disposition at discharge, and 3) factors predictive of baseline measures (at discharge) of the primary outcomes. We will then systematically evaluate the effect of potentially important psychosocial modifiers (e.g., coping strategies) on variation in functioning over time both within and between groups.
FINDINGS/RESULTS:
Project is in data collection. No results at this time.
IMPACT:
Anticipated Impacts on Veteran's Healthcare: OEF/OIF military personnel are more likely to survive combat burns than veterans of earlier conflicts, but the long-term functional outcomes after combat burns are unknown. The little we know is inferred from data for civilian burn patients, for whom there is very little evidence regarding long-term functional recovery. This collaboration between the VERDICT REAP, the U.S. Army Institute of Surgical Research Burn Center (USAISR), and Brooke Army Medical Center (BAMC), all co-located in San Antonio, is the first to systematically assess long-term outcomes in OEF/OIF personnel with combat burns and compare them to OEF/OIF personnel with noncombat trauma and civilian burn patients. This work will be critical to understanding the long-term impact of burn injuries on subsequent functioning and disability among veterans. Impact of the first year's work includes building successful collaborative relationships at BAMC and the USAISR, gaining understanding of the DOD IRB processes, policies and approaches for future research.
PUBLICATIONS:
None at this time.
DRA:
Acute and Traumatic Injury, Health Services and Systems, Military and Environmental Exposures
DRE:
Rehabilitation, Quality of Care, Epidemiology
Keywords:
Pain, Operation Enduring Freedom, Operation Iraqi Freedom
MeSH Terms:
none
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