PMID- 27768658
OWN - NLM
STAT- MEDLINE
DCOM- 20170517
LR  - 20221207
IS  - 2163-0763 (Electronic)
IS  - 2163-0755 (Linking)
VI  - 81
IP  - 5 Suppl 2 Proceedings of the 2015 Military Health System Research Symposium
DP  - 2016 Nov
TI  - The Military Orthopedic Trauma Registry: The potential of a specialty specific 
      process improvement tool.
PG  - S100-S103
AB  - BACKGROUND: The Military Orthopaedic Trauma Registry (MOTR) was designed to 
      replicate the Department of Defense Trauma Registry's (DoDTR's) role as pillar 
      for data-driven management of extremity war wounds. The MOTR continuously 
      undergoes quality assurance checks to optimize the registry data for future 
      quality improvement efforts. We conducted a quality assurance survey of MOTR 
      entrants to determine if a simple MOTR data pull could provide robust 
      orthopedic-specific information toward the question of causes for late 
      amputation. METHODS: Forty-five entrants into the DoDTR with late transtibial 
      amputation were sequentially abstracted into MOTR by MOTR data abstractors. The 
      MOTR record was then examined by an independent reviewer for three data fields 
      pertaining to the events leading up to the late amputation: injury before limb 
      amputation, complications before and after amputation, and complication or other 
      factor directly contributing to the decision for amputation. RESULTS: Thirty-nine 
      subjects had at least one fracture of the tibial diaphysis, tibial pilon, 
      calcaneus, or multiple foot fractures. Twenty-nine fractures were described as 
      open injuries for which 27 included a Gustilo and Anderson classification in the 
      available data fields. Complications could be identified along the treatment 
      course for 43 of the 45 entrants specific to the amputated limb. A directly 
      contributing factor to late amputation was identified in 36 (80%) of the 
      subjects. Infection, either alone or associated with fracture nonunion, was a 
      contributing factor in 46% of late amputations. Wound infection was the most 
      common complication both before and after the amputation. CONCLUSION: The MOTR, 
      using a simple data extraction from a few registry fields, can provide a robust 
      amount of information that can direct process and care improvement for severely 
      injured limbs by providing the level of detail pertinent to an orthopedic 
      surgeon. LEVEL OF EVIDENCE: Prognostic/epidemiological study, level IV.
FAU - Rivera, Jessica C
AU  - Rivera JC
AD  - From the Department of Orthopaedic Surgery (J.C.R.), US Army Institute of 
      Surgical Research and San Antonio Military Medical Center, JBSA Fort Sam Houston, 
      Texas; US Army Institute of Surgical Research (R.M.G.), JBSA Fort Sam Houston, 
      Texas; Joint Trauma System (M.A.S.), JBSA Fort Sam Houston, Texas; and Department 
      of Orthopaedic Surgery (A.E.J.), San Antonio Military Medical Center, JBSA Fort 
      Sam Houston, Texas.
FAU - Greer, Renee M
AU  - Greer RM
FAU - Spott, Mary Ann
AU  - Spott MA
FAU - Johnson, Anthony E
AU  - Johnson AE
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Trauma Acute Care Surg
JT  - The journal of trauma and acute care surgery
JID - 101570622
SB  - IM
MH  - Amputation, Surgical/*statistics & numerical data
MH  - Armed Conflicts
MH  - Fractures, Bone/*epidemiology/surgery
MH  - Humans
MH  - Leg Injuries/*epidemiology/surgery
MH  - *Military Medicine
MH  - *Military Personnel
MH  - Orthopedics
MH  - *Quality Assurance, Health Care
MH  - *Registries
MH  - United States
EDAT- 2016/10/22 06:00
MHDA- 2017/05/18 06:00
CRDT- 2016/10/22 06:00
PHST- 2016/10/22 06:00 [pubmed]
PHST- 2017/05/18 06:00 [medline]
PHST- 2016/10/22 06:00 [entrez]
AID - 01586154-201611002-00008 [pii]
AID - 10.1097/TA.0000000000001145 [doi]
PST - ppublish
SO  - J Trauma Acute Care Surg. 2016 Nov;81(5 Suppl 2 Proceedings of the 2015 Military 
      Health System Research Symposium):S100-S103. doi: 10.1097/TA.0000000000001145.