Trauma Infections Research Description
The current conflicts combined with ever challenging antimicrobial resistance dramatically emphasize the critical need for ongoing research efforts to improve prevention and management of infections following traumatic injury. Recent advances in battlefield surgical practice and technology, including rapid evacuation, have fortunately led to an increased number of survivors following combat-associated traumatic injuries. Infections are common complications of the many complex poly-trauma cases now seen in military treatment facilities (MTF) and can lead to significant morbidity and mortality. Treatment of these infections, primarily hospital-associated, is clinically challenging, as many are caused by multidrugresistant organisms (MDRO), and there is a lack of evidence-based recommendations to guide clinicians toward effective treatment and prevention methods. Developing a responsive research portfolio to address these concerns has a high priority of the IDCRP.
Studies
Trauma-related infections (particularly combat injuries) epidemiology, prevention and management/ Hospital-acquired infections with focus on multidrug-resistant organisms (MDRO) management challenges
TIDOS
This is an observational cohort study of short and long term infectious disease outcomes following a deployment-related traumatic injury. The eligible study population includes DoD beneficiaries and active duty personnel transferred from Landstuhl Regional Medical Center (LRMC; Landstuhl, Germany) to one of two tertiary care facilities (Walter Reed National Military Medical Center [WRNMMC, Bethesda, MD; formerly Walter Reed Army Medical Center, Washington DC and National Naval Medical Center, Bethesda, MD] and San Antonio Military Medical Center [SAMMC, San Antonio, TX; formerly Brooke Army Medical Center, Ft Sam Houston, TX and Wilford Hall Medical Center, San Antonio, TX]) to receive inpatient treatment for a traumatic injury experienced during an overseas deployment. Trauma history, post-injury hospital management including antimicrobial therapy, infection outcomes, and clinical microbiology are captured on the complete trauma patient population through LRMC hospitalization and through the initial US hospitalization for those patients transferred to a participating US site. Informed consent and enrollment are achieved prior to discharge or transfer during a subject's initial CONUS hospitalization. The longitudinal cohort follow-up period is estimated at a minimum of five years. Various follow-up approaches are used (as appropriate): in-person and telephonic interviews, interaction with healthcare providers, medical record review, and query of electronic healthcare databases (such as the JTTR, the U.S. Navy-Marine Corps Combat Trauma Registry [CTR], or the National Department of Veterans Affairs Healthcare Databases).
TIDOS
This is an observational cohort study of short and long term infectious disease outcomes following a deployment-related traumatic injury. The eligible study population includes DoD beneficiaries and active duty personnel transferred from Landstuhl Regional Medical Center (LRMC; Landstuhl, Germany) to one of two tertiary care facilities (Walter Reed National Military Medical Center [WRNMMC, Bethesda, MD; formerly Walter Reed Army Medical Center, Washington DC and National Naval Medical Center, Bethesda, MD] and San Antonio Military Medical Center [SAMMC, San Antonio, TX; formerly Brooke Army Medical Center, Ft Sam Houston, TX and Wilford Hall Medical Center, San Antonio, TX]) to receive inpatient treatment for a traumatic injury experienced during an overseas deployment. Trauma history, post-injury hospital management including antimicrobial therapy, infection outcomes, and clinical microbiology are captured on the complete trauma patient population through LRMC hospitalization and through the initial US hospitalization for those patients transferred to a participating US site. Informed consent and enrollment are achieved prior to discharge or transfer during a subject's initial CONUS hospitalization. The longitudinal cohort follow-up period is estimated at a minimum of five years. Various follow-up approaches are used (as appropriate): in-person and telephonic interviews, interaction with healthcare providers, medical record review, and query of electronic healthcare databases (such as the JTTR, the U.S. Navy-Marine Corps Combat Trauma Registry [CTR], or the National Department of Veterans Affairs Healthcare Databases).
Case-Control Osteomyelitis
"Subjects who meet eligibility criteria as cases and matched controls will be identified through a query of orthopedic trauma ICD-9-CM codes in the Military Health System Data Repository, which is maintained by TRICARE Management Activity. Step 1 of Case and Control Determination is the Case and Control Selection process. At this stage, a case is defined as an individual who received a diagnosis of osteomyelitis as reported in the MDR using the pre-specified osteomyelitis ICD-9-CM codes. Controls will be preliminarily matched at this step based on date of injury (+/- 2 months), location of orthopedic injury (upper extremity versus lower extremity versus spine/pelvis), and first continental United States (CONUS) inpatient admission facility (WRAMC, SAMMC, NNMC). Data sharing partners at the NMCPHC EpiData Center, USAISR, and NHRC will cross check the list of subjects and data elements provided to locate the individuals and their records in their specific databases. A one time export of data from these databases will be sent to the DCAC to be included in the study database.
Step 2 of Case and Control Determination is Case and Control Verification which relies upon clinical and symptom-based criteria for osteomyelitis. Completion of data points will occur through abstraction of paper and electronic medical records onto CRFs by Clinical Research Coordinators (CRC) at the MTF sites (and VA for those who have an osteomyelitis ICD-9 code while at the VA).