PMID- 33079837 OWN - NLM STAT- MEDLINE DCOM- 20210621 LR - 20221207 IS - 1531-2291 (Electronic) IS - 0890-5339 (Linking) VI - 35 IP - 3 DP - 2021 Mar 1 TI - Pain, Depression, and Posttraumatic Stress Disorder Following Major Extremity Trauma Among United States Military Serving in Iraq and Afghanistan: Results From the Military Extremity Trauma and Amputation/Limb Salvage Study. PG - e96-e102 LID - 10.1097/BOT.0000000000001921 [doi] AB - OBJECTIVES: Assess the burden and co-occurrence of pain, depression, and posttraumatic stress disorder (PTSD) among service members who sustained a major limb injury, and examine whether these conditions are associated with functional outcomes. DESIGN: A retrospective cohort study. SETTING: Four U.S. military treatment facilities: Walter Reed Army Medical Center, National Naval Medical Center, Brooke Army Medical Center, and Naval Medical Center San Diego. PATIENTS/PARTICIPANTS: Four hundred twenty-nine United States service members who sustained a major limb injury while serving in Afghanistan or Iraq met eligibility criteria upon review of their medical records. INTERVENTION: Not applicable. MAIN OUTCOME MEASUREMENTS: Outcomes assessed were: function using the short musculoskeletal functional assessment; PTSD using the PTSD Checklist and diagnostic and statistical manual criteria; pain using the chronic pain grade scale. RESULTS: Military extremity trauma and amputation/limb salvage patients without pain, depression, or PTSD, were, on average, about one minimally clinically important difference (MCID) from age- and gender-adjusted population norms. In contrast, patients with low levels of pain and no depression or PTSD were, on average, one to 2 MCIDs from population norms. Military extremity trauma and amputation/limb salvage patients with either greater levels of pain, and who experience PTSD, depression, or both, were 4 to 6 MCIDs from population norms. Regression analyses adjusting for injury type (upper or lower limb, salvage or amputation, and unilateral or bilateral), age, time to interview, military rank, presence of a major upper limb injury, social support, presence of mild traumatic brain injury/concussion, and combat experiences showed that higher levels of pain, depression, and PTSD were associated with lower one-year functional outcomes. CONCLUSIONS: Major limb trauma sustained in the military results in significant long-term pain and PTSD. Overall, the results are consistent with the hypothesis that pain, depression, and PTSD are associated with disability in this population. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. CI - Copyright (c) 2020 Wolters Kluwer Health, Inc. All rights reserved. FAU - Castillo, Renan C AU - Castillo RC AD - Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. FAU - Carlini, Anthony R AU - Carlini AR AD - Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. FAU - Doukas, William C AU - Doukas WC AD - UHC Orthopedics, Bridgeport, WV. FAU - Hayda, Roman A AU - Hayda RA AD - Rhode Island Hospital, Brown University, Providence, RI. FAU - Frisch, Harold M AU - Frisch HM AD - Orthopaedic Trauma Service, Mission Hospital, Asheville, NC. FAU - Andersen, Romney C AU - Andersen RC AD - Walter Reed National Military Medical Center, Bethesda, MD. AD - Riverside Health System, Newport News, VA. FAU - D'Alleyrand, Jean-Claude AU - D'Alleyrand JC AD - Walter Reed National Military Medical Center, Bethesda, MD. AD - Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD; and. FAU - Mazurek, Michael T AU - Mazurek MT AD - Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. AD - UHC Orthopedics, Bridgeport, WV. AD - Rhode Island Hospital, Brown University, Providence, RI. AD - Orthopaedic Trauma Service, Mission Hospital, Asheville, NC. AD - Walter Reed National Military Medical Center, Bethesda, MD. AD - Riverside Health System, Newport News, VA. AD - Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD; and. AD - Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, Fort Sam Houston, TX. FAU - Ficke, James R AU - Ficke JR AD - Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, Fort Sam Houston, TX. FAU - Keeling, John J AU - Keeling JJ AD - Walter Reed National Military Medical Center, Bethesda, MD. FAU - Pasquina, Paul F AU - Pasquina PF AD - Walter Reed National Military Medical Center, Bethesda, MD. FAU - Wain, Harold J AU - Wain HJ AD - Walter Reed National Military Medical Center, Bethesda, MD. FAU - MacKenzie, Ellen J AU - MacKenzie EJ AD - Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. LA - eng PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Orthop Trauma JT - Journal of orthopaedic trauma JID - 8807705 SB - IM MH - Afghanistan MH - Amputation, Surgical MH - Depression/epidemiology/etiology MH - Humans MH - Iraq MH - Iraq War, 2003-2011 MH - Limb Salvage MH - Lower Extremity MH - *Military Personnel MH - Pain MH - Retrospective Studies MH - *Stress Disorders, Post-Traumatic/diagnosis/epidemiology MH - United States/epidemiology COIS- The authors report no conflict of interest. EDAT- 2020/10/21 06:00 MHDA- 2021/06/22 06:00 CRDT- 2020/10/20 17:10 PHST- 2020/07/31 00:00 [accepted] PHST- 2020/10/21 06:00 [pubmed] PHST- 2021/06/22 06:00 [medline] PHST- 2020/10/20 17:10 [entrez] AID - 00005131-202103000-00015 [pii] AID - 10.1097/BOT.0000000000001921 [doi] PST - ppublish SO - J Orthop Trauma. 2021 Mar 1;35(3):e96-e102. doi: 10.1097/BOT.0000000000001921.