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BACKGROUND/RATIONALE:
Operations Iraqi and Enduring Freedom (OIF/OEF) are presenting new challenges for the VA health care delivery system. Despite improvements in body armor and surgical stabilization at the front-line of combat, returning service members are presenting with complex, multiple injuries in unpredictable patterns, known as Polytrauma/Blast-Related Injury (PT/BRI). PT/BRI is a new phenomenon and the epidemiology is not well defined, particularly for the "less visible" physical and psychological sequelae. Characterizing PT/BRI is challenging because the medical and psychiatric sequelae, such as ear trauma and resultant hearing loss, concussion and resultant cognitive and vestibular deficits, and posttraumatic stress disorder (PTSD) may be missed when attention is focused on more "visible" injuries, such as amputations or burns.
OBJECTIVE(S):
The purpose of this proposed project is to further define the epidemiology of exposure to war-related explosions (PT/BRI) with an emphasis on the identified gaps in knowledge (i.e., less visible sequelae) so that we may be able to modify the natural history of these blast-related injuries, minimizing the adverse sequelae and maximizing recovery. Specific objectives include: (1) Describe the prevalence of physical and psychological symptoms associated with blast events. (2) Create a set of symptom profiles that will allow us to begin development of a taxonomy of PT/BRI with specific attention to the mechanism of explosion, time since exposure, nature of immediate injury of any blast exposure, severity of initial injury, and persistent symptoms. (3) Using grounded theory methodology, develop a substantive theory describing how persons exposed to war-related blasts understand their healthcare experiences.
METHODS:
RESEARCH DESIGN: This 2 year population-based study will characterize the OIF experiences with PT/BRI among the 15,000 members of the Florida National Guard. A mixed methods approach will be used involving quantitative methods to obtain information on exposure to, and sequelae of, blast exposures (Objectives 1 and 2) with qualitative methods to inform us regarding the personalized experience of blast exposure in the subset so exposed (Objective 3). The quantitative component includes three groups from the Florida National Guard (FNG): 1) 100% sample of those deployed and exposed to one or more blasts (n=~400) and 2) deployed and not exposed to blasts (n=~2200); and 3) a ~20% sample of the estimated 12,400 not deployed. The self-administered survey will collect the following information on the service members: demographics, current physical injuries or problems and psychological health, current co-morbidities, and current health-related quality of life. For those exposed to blasts in Iraq, blast exposure history, body region(s) injured by the blast, and injury severity. We will complete physical exams on a subset of respondents to validate self-reported injuries and conditions. For the qualitative component, a convenience sample of 30 who were exposed to blasts in Iraq will be interviewed regarding their lived experience of blast exposure.
ANALYSIS: For Objective 1, unadjusted and adjusted prevalence rates for blast exposure, blast-related injuries, and psychological trauma will be computed. For Objective 2 a taxonomy of persistent physical and psychological symptoms will be developed using generalized linear models to evaluate the significance of blast exposure in conveying increased risk for continuous indices of specific physical, neurobehavioral, psychological, and alcohol abuse symptom severity. Methods based in Item Response Theory will be employed to understand individual patterns of specific symptoms and we will examine the link between these persistent symptoms and important longer-term outcomes such as quality of life. For the third objective, the qualitative interviews will be taped, transcribed, and analyzed using constant comparative analysis to examine the experience of blast exposure from the patient's perspective.
FINDINGS/RESULTS:
The project was just funded. There are no results yet.
IMPACT:
This study addresses a health priority in the VA. By generating a more complete description of the epidemiology of blast exposure, including prevalence rate of physical and psychological symptoms/injuries associated with blast exposure and mortality rates, we will have essential information for understanding the magnitude of occurrence and array of injuries sustained from blast exposure. This will be summarized through a taxonomy of PT/BRI. From the taxonomy, we anticipate deriving a risk assessment tool for soldiers exposed to blast so that diagnostic work-ups are more complete and identified conditions can be treated earlier. Other system improvements for the treatment of PT/BRI are anticipated from the patient-centered inventory of needed interventions, in which barriers, facilitators, and contextual features are identified. Research contributions including guidance to ongoing the QUERI initiative to develop an information management system for PT/BRI and hypotheses and research questions, grounded in the qualitative data, for further study.
PUBLICATIONS:
None at this time.
DRA:
Acute and Traumatic Injury, Military and Environmental Exposures, Special (Underserved, High Risk) Populations
DRE:
Epidemiology, Rehabilitation
Keywords:
Deployment Related, Operation Enduring Freedom, Operation Iraqi Freedom
MeSH Terms:
none
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