The Military Orthopaedic Trauma Registry: The Potential of a Specialty Specific Process Improvement Tool.

Background: The Military Orthopaedic Trauma Registry (MOTR) was designed to replicate the Department of Defense Trauma Registry's (DoDTR) role as pillar for data-driven management of extremity war wounds. MOTR continuously undergoes quality assurance checks to optimize the registry data for future quality improvement efforts. We conducted a quality assurance survey of MOTR entrants to determine if a simple MOTR data pull could provide robust orthopaedic specific information towards the question of causes for late amputation. Methods: Forty-five entrants into the DoDTR with late trans tibial amputation were sequentially abstracted into MOTR by MOTR data abstractors. The MOTR record was then examined by an independent reviewer for three data fields pertaining to the events leading up to the late amputation: injury prior to limb amputation, complications before and after amputation, and complication or other factor directly contributing to the decision for amputation. Results: Thirty-nine subjects had at least one fracture of the tibial diaphysis, tibial pilon, calcaneus, or multiple foot fractures. Twenty-nine fractures were described as open injuries for which 27 included a Gustilo and Anderson classification in the available data fields. Complications could be identified along the treatment course for 43 of the 45 entrants specific to the amputated limb. A directly contributing factor to late amputation was identified in 36 (80%) of subjects. Infection, either alone or associated with fracture nonunion, was a contributing factor in 46% of late amputations. Wound infection was the most common complications both before and after the amputation. Conclusion: MOTR, using a simple data extraction from a few registry fields, can provide a robust amount of information which can direct process and care improvement for severely injured limbs by providing the level of detail pertinent to an orthopaedic surgeon. Level of Evidence: Level IV Prognostic/Epidemiological Study (C) 2016 Lippincott Williams & Wilkins, Inc.

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