Evaluation of the Effectiveness of the 2008 Postsplenectomy Vaccination Joint Theater Trauma System Clinical Practice Guideline. Issue 11 (1st November 2015)

• Record Type: Journal Article
• Authors: Mitchell, Thomas A.; Wallum, Timothy E.; White, Christopher E.; Sanders, Kelly E.; Aden, James K.; Bailey, Jeffrey A.; Blackbourne, Lorne H.; Murray, Clinton K.
• Is Part Of: Military medicine. Volume 180:Issue 11(2015)
• Page Start: 1170
• Page End: 1177
• Publication Date: 2015-11-01
• Subjects: Surgery, Military -- Societies, etc; Medicine, Military -- Societies, etc; Medicine, Military -- Periodicals; Surgery, Military -- Periodicals; Medicine, Military; Surgery, Military; Military Medicine -- Periodicals; Periodicals; Electronic journals; 616.98023
• DOI: 10.7205/MILMED-D-14-00295
• Languages: English
• ISSNs: 0026-4075

Abstract

ABSTRACT: Objectives: Postsplenectomy vaccination (PSV) in an austere environment to minimize overwhelming postsplenectomy infection is challenging. We evaluated the clinical impact of a March 2008 clinical practice guideline (CPG) dictating immediate PSV at North American Treaty Organization Role 3 medical treatment facilities and subsequent complications. Methods: Utilizing U.S. military medical databases, we characterized all U.S. patients with a splenic injury from November 2002 to January 2012 by their surgical management: laparotomy with splenectomy (LWS), laparotomy without splenectomy, or nonoperative management. Relevant data including demographics, vaccinations, and documented bacterial and fungal isolates were obtained. Results: LWS comprised 63.6% of the 409 patients with a splenic injury from 2002 to 2012. The implementation of the PSV CPG improved overall vaccination compliance from 48.9% pre-PSV CPG to 86.9% post-PSV CPG ( p < 0.01). It was found that 1.3% (2/159) of completely vaccinated LWS patients compared with 0% (0/101) of the incompletely vaccinated LWS patients had Streptococcus pneumoniae isolates in 391.0 and 251.4 follow-up years, respectively ( p = 0.52). No Neisseria meningitidis or Haemophilus influenzae isolates were identified. Conclusions: PSV CPG implementation improved theater vaccination without increasing the incidence of encapsulated organisms.