Transitional Care of Service Members with Genitourinary Injury

Abstract

Objective: To improve urotrauma care by describing veterans' current demographics and needs assessment during transitional care to the Veteran Health Administration (VHA) system. Methods: We utilized our previously identified cohorts obtained from the DoD Trauma Registry data for male service members injured in theater linked with VHA electronic health records. We included veterans who received care at VHA at least once from October 2001 through September 2011 for chart review. We investigate demographics, opportunities for care, combat-related trauma, disability, and associated mental health or urologic conditions specifically at the initial encounter with a VHA healthcare provider. Results: We queried 580 veterans' records in VHA from the linked databases. We idenfied that 141 (24.4%) veterans received addional care outside VHA and 17.1% (n = 99) of charts had insufficient data for injury validation. Reference to the urotrauma was mentioned in 72% of VHA initial visits (n = 416/580). The most common urotrauma occurred to the lower/external genitourinary injury (298, 51%). Of all the veterans identified with genitourinary trauma, approximately 28% (n = 160) were referred for urologic consultation, but only 14% were related to the original urotrauma. Ninety percent (522/580) of service members with urotrauma also had a mental health diagnosis, largely post-traumatic stress disorder (PTSD, 70.8%). Conclusions: The majority of men with urotrauma did have contact with VHA, yet there is no systematic approach to baseline assessment or long-term care strategy. However, only a small proportion of DoD-documented urotrauma requires ongoing care. We identified that coordinating care with mental health pathways (PTSD/traumatic brain injury) may be an opportunity to evaluate the long-term effects of urotrauma.