Military Extremity Trauma Amputation/Limb Salvage Study: Long-Term Follow-up


Principal Investigator: Ellen J. MacKenzie, PhD


Although major limb trauma resulting from combat in Iraq and Afghanistan is common, little is known about how treatment of these injuries impacts outcomes, leaving clinicians with little data to guide decisions in the acute and post-acute care settings. The Military Extremity Trauma and Amputation/Limb Salvage (METALS I) Study examined these differences using a retrospective cohort study of service members deployed to Afghanistan or Iraq between 2003-2007 who sustained major limb trauma to the upper and/or lower limbs resulting in amputation or limb salvage. Results from interviews and medical record abstraction (n=429) showed that major limb trauma leads to significant physical and psychosocial disability. Disability was prevalent among both amputees and limb salvage participants in METALS I, and, in a finding that contradicted previous research in civilian populations, patients with lower limb trauma who underwent amputation experienced significantly better outcomes than those undergoing limb salvage.

The METALS II study will extend the follow-up of the original METALS cohort to examine longer term outcomes and enroll a new cohort of METALS patients injured in later years of OIF/OEF/OND who may have benefited from improvements in limb salvage care. It will also leverage exciting new opportunities for linking outcome data with data on the long-term use of services paid for by the military and VA (data not available in METALS I).

This study will provide a comprehensive longitudinal assessment of the clinical, functional and mental health consequences of major limb trauma and add to our understanding of the long-term benefits of reconstruction vs. amputation for the most severely injured. Importantly, we will be able to examine potential differences in care and outcomes for those injured earlier and later in OIF/OEF/OND to identify changes in care that may have influenced service use and outcomes. The study will also provide important information on where service members injured in OIF/OEF/OND are currently obtaining services, their perception of unmet need for services and some insight into barriers to obtaining necessary care. The study will lead to the development of a comprehensive database on the long-term outcomes of major limb trauma that can be used to address multiple ancillary research questions. It can also facilitate ongoing surveillance of this critically injured group to learn how best to address their long-term needs.

Sponsored by: DoD PRORP/CDMRP