MP59-13 BURNS TO THE PERINEAL REGION INCREASE THE RISK OF DEATH AMONG U.S. SERVICE MEMBERS SUSTAINING COMBAT-RELATED BURNS DURING OPERATION IRAQI FREEDOM AND OPERATION ENDURING FREEDOM

INTRODUCTION AND OBJECTIVES: Improvements in battlefield medical care during Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) have led to high rates of survival among U.S. service members (SMs) with complex polytrauma. These include unprecedented numbers of U.S. military personnel surviving with genitourinary (GU) injuries and comorbid extremity amputations. Although comorbid GU injury and amputation have been described as a “signature wound” of the wars in Iraq and Afghanistan, the epidemiology of this injury pattern has not previously been described. The objective of this study was to describe the demographic characteristics and prevalence of battlefield GU injuries associated with extremity amputations. METHODS: The Department of Defense Trauma Registry (DoDTR) was reviewed to identify all male U.S. SMs diagnosed with GU injury from 2001 to 2013. The DoDTR includes data for wounded SMs treated at any U.S. combat support hospital, the in-theater equivalent of a civilian trauma center. Genitourinary injuries and amputations were identified using Abbreviated Injury Scale (AIS) injury codes and/or ICD9-CM diagnosis codes. Individuals with GU injury only were compared with those with both GU injury and amputations. SMs who died of wounds were excluded. Basic demographic and injury characteristics were analyzed. RESULTS: Among the 1,291 surviving male SMs who sustained GU injury during OIF/OEF, 407 (31.5%) had one or more extremity amputation(s), including 247 (19.1%) SMs with lower extremity amputation(s) only, 43 (3.3%) SMs with upper extremity amputation only, and 117 (9.1%) SMs with both lower and upper extremity amputation(s). Compared to SMs with GU injury only, those with GU injury and amputation(s) were more often injured by an explosive mechanism (64.0% vs. 97.3%) and had higher overall injury severity scores (ISS 26 in 27.8% vs. 51.9%; p < 0.0001). When all SMs with lower extremity amputation(s) were evaluated (regardless of upper extremity amputation status), a total of 283 (22.0%) had above the knee amputation(s). Compared to those with other amputations, a greater proportion of individuals with above the knee amputations had severe GU injuries (21.6% vs. 78.4%; p < 0.0001). CONCLUSIONS: Extremity amputation is a common comorbid condition among the large number of U.S. SMs who sustained GU injury during OIF/OEF. The impact of comorbid GU injury and extremity amputation on long term functional outcomes and overall quality of life remains unclear but is being investigated.