Department of Defense Trauma Registry Infectious Disease Module Impact on Clinical Practice

Area of Science:

• Military Medicine
• Infectious Diseases
• Trauma Surgery

Background:

• The Joint Trauma System (JTS) is a Department of Defense (DoD) Center of Excellence for military health system trauma care.
• The JTS develops and refines evidence-based clinical practice guidelines (CPGs) to improve combat casualty care.
• A centralized DoD Trauma Registry supports process improvement, with specialty modules evolving over time.

Purpose of the Study:

• To review the implementation of the JTS DoD Trauma Registry's Infectious Disease Module.
• To describe the development of infection-related CPGs.
• To summarize the impact of the Infectious Disease Module on combat casualty care and guidelines.

Main Methods:

• The DoD Trauma Registry Infectious Disease Module collected infection-related data from deployed military personnel.
• Data were gathered from June 2009 to December 2014, initially at Landstuhl Regional Medical Center, Germany, then in US military hospitals.
• Collaboration with the Infectious Disease Clinical Research Program (IDCRP) Trauma Infectious Disease Outcomes Study (TIDOS) was integral.

Main Results:

• Data analyses assessed compliance with JTS CPG antibiotic prophylaxis recommendations, showing improved adherence over time, especially for open fractures.
• An analysis supported JTS recommendations for cefazolin use in open fractures, finding no difference in osteomyelitis rates and reduced resistant Gram-negative organisms.
• The module was refined to capture data for investigating invasive fungal infections (IFIs), supporting IFI CPG development.

Conclusions:

• Expansion, refinement, and sustainability of the DoD Trauma Registry Infectious Disease Module are necessary.
• Real-time surveillance of infectious disease trends and outcomes is crucial for future conflicts.
• Improvements aim to mitigate high-consequence infections and enhance combat casualty care, especially during prolonged field care.