Complex Casualty Care by Elizabeth Farrar

Liz completed her thesis at NPS in September 2013.  While at NPS, Liz created some critical links between the NPS Operations Research department and the Navy Bureau of Medicine and Surgery, BUMED.  In her thesis, she analyzes care for critical injury patients.

Executive Summary

In an effort to better understand the factors that influence the treatment effectiveness of combat casualty amputee patients, our study analyzes the data of 182 amputee patients within the Comprehensive Combat and Complex Casualty Care (C5) program through the use of logistic and linear regression models. The analysis examines two response variables, duration in the program and opiate drug usage, as a function of patient demographics, injury type, and appointment statistics. In particular, we look at the following exploratory variables: patient race and age; presence of a traumatic brain injury and mental health condition; amputation caused by an improvised explosive device (IED) or not; number of patient medical conditions; number of follow-up surgeries; location of amputation; and the percentage of “no show,” “cancelled,” and “kept” patient rehabilitation appointments.

The main results of our study show that:

  • An increase in attendance to physical therapy, occupational therapy, and pain management and rehabilitation appointments correlates to an increased likelihood of reduced opiate usage.
  • The estimated probability of a reduction in opiate usage is less likely as the patient ages and the number of primary medical conditions increases.
  • Patients without an IED injury spend more time in the program as the number of primary conditions increase.
  • Percentage of cancelled appointments is positively associated with the treatment duration of upper-body amputees, patients with both an upper and lower amputation, and amputations caused by an IED.
  • The number of follow-up surgeries, presence of a traumatic brain injury, and mental health condition did not have a significant impact on opiate usage or duration in the program.

The results of our study and similar studies could be used for future meta-analysis work to determine if similar correlations are repeated in other Military Treatment Facility (MTF) amputee populations.

Thesis Presentation

Complete Thesis

Farrar, E. D. (2013).  Treatment Effectiveness of Complex Casualty Amputee Patients(Masters Thesis).  Naval Postgraduate School.


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