service members as they age. The EACE researchers are con-
tinuing to develop and validate the CHAMP for female service
members as well as other novel outcome measures that will
improve the health of injured service members and veterans.
The EACE researchers are currently focused on conduct-
ing epidemiologic studies to evaluate the morbidity and mor-
tality rates of two core patient cohorts with the long-term goal
of maximizing their health and QoL outcomes. Speci
fically,
individuals with severe extremity injuries have been strati
fied
into those with (1)
“acutely threatened limbs” that required
immediate consideration for amputation and (2)
“functionally
impaired limbs
” that do not require immediate consideration
for amputation but cause signi
ficant limitations. The EACE
researchers use local clinical data records, Defense Manpower
Data Center records, the Expeditionary Medical Encounter
Database (EMED), the Medical Health System Data Reposi-
tory, the VA Corporate Data Warehouse, and multiple other
data sources to conduct research. Central to the EACE epi-
demiological efforts is the ability to access the EMED, a gold
standard repository of high-quality, veri
fied, and validated com-
bat casualty data spanning the spectrum of care and rehabilita-
tion.
71,72
Within the EMED, each casualty injury record is
coded by in-house Naval Health Research Center clinical staff
on diagnoses (International Classi
fication of Diseases-9/10
codes) and on injury severity, using both the Abbreviated Injury
Scale and Abbreviated Injury Scale-2005 Military. Coded injury
data are then mapped to tactical data describing the character-
istics of the casualty event, descriptions of treatments adminis-
tered within the chain of evacuation, predeployment- and
postdeployment- related health information, personnel data with
career and dependent history data, and
finally, with longitudi-
nal, prospective QoL outcome data.
In addition to performing retrospective epidemiologic
studies, the EACE researchers have begun prospective longi-
tudinal efforts to examine rehabilitative and QoL outcomes.
Another key facet to the EACE R&S directorate is the
Wounded Warrior Recovery Project (WWRP). The WWRP
is a 16-year, longitudinal, prospective, informed-consent
study being conducted through Naval Health Research Cen-
ter, which tracks long-term QoL, mental health outcomes,
pain experiences, social support, and prosthetic/orthotic use
and satisfaction.
73
Funding for the WWRP is through U.S.
Navy Bureau of Medicine and Surgery.
Complementary to the WWRP, additional surveillance
studies are aimed at understanding the prevalence and pre-
vention of developing secondary health conditions following
severe extremity trauma, such as osteoarthritis, obesity, car-
diovascular disease, and low back pain. These secondary
conditions may exacerbate an existing disability caused by
the initial extremity injury.
74,75
Among these secondary con-
ditions, delayed amputations receive particular attention as
individuals may eventually choose or require an elective
amputation to recover function. Delayed amputations, occur-
ring more than 90 days after initial injury, account for 10 to
15% of all combat-related amputations
76
and correlate with
adverse physical and psychological diagnoses.
72
Future studies
will work to identify early predictors of delayed amputations
including the speci
fic injury, wound complications, and reha-
bilitation therapies that may increase or decrease the likelihood
of amputation.
Findings from the EACE Epidemiology and Surveillance
research focus area support EACE-speci
fic needs related to
rehabilitating and reintegrating injured service members and
veterans. This research will help inform DoD and VA clini-
cal practice recommendations, guidelines, and policy on
extremity trauma and amputation care.
Medical and Surgical Innovations
In recent years, signi
ficant efforts have been devoted toward
developing advanced medical therapies and surgical tech-
niques to improve the restoration of tissue form and function
following traumatic composite tissue injury. The EACE, col-
laborating with ongoing research efforts at WRNMMC and
the Uniformed Services University of the Health Sciences, is
in the early stages of building a capability to conduct pre-
clinical and clinical research in the broad area of medical
and surgical innovations. The overarching goal of the EACE
Medical and Surgical Innovations research focus area is to
foster the development of next-generation regenerative medi-
cine therapeutics and innovative surgical approaches and to
accelerate the translation of the best-performing technologies
to the clinic.
Regenerative Medicine (RM) focuses on replacing or
regenerating human cells, tissues, or organs to restore or
establish normal form and function.
77
Next-generation regen-
erative medicine therapeutics focused on restoring tissues of
the extremities (i.e., muscle, bone, tendon, ligament, nerve)
are particularly relevant for service members and veterans
with extremity trauma and/or amputation. Additionally, many
of these therapeutics that have been developed and/or investi-
gated were supported, at least in part, by DoD and/or VA,
such as the Armed Forces Institute of Regenerative Medicine.
Examples of topics currently under investigation by the
EACE researchers include the clinical evaluation of a biologic
scaffold material to aid in the restoration of tissue structure
and function following volumetric muscle loss; the preclinical
evaluation of the mechanisms that drive biomaterial mediated
tissue regeneration as a means to facilitate rational design of
next-generation RM materials and therapeutics; the develop-
ment of 3-dimensional bio-printing; and whole organ engi-
neering capabilities, among others.
Several innovative surgical approaches have been devel-
oped to facilitate tissue reconstruction and improve limb
function for individuals with traumatic extremity injuries.
Examples include targeted muscle reinnervation
78
for pros-
thetic control and osseointegration, in which a prosthesis is
attached directly to the skeleton of a patient with an amputa-
tion.
79
The EACE researchers are currently participating in
several osseointegration studies, led by clinicians at WRNMMC,
MILITARY MEDICINE, Vol. 181, November/December Supplement 2016
9
EACE: Overview of the Research and Surveillance Division