On July 26, the U.S. Department of Defense (DOD) approved a $1.5 million grant to AAOS to help develop six clinical practice guidelines (CPGs) and six appropriate use criteria (AUCs) over the next 4 years. The grant was obtained as part of a collaborative effort with the Major Extremity Trauma Research Consortium (METRC), and coordinated through the Data and Research Coordinating Center of the Johns Hopkins Bloomberg School of Public Health.

METRC is a nonprofit collaborative effort of 22 civilian centers and 4 military treatment facilities dedicated to helping establish treatment guidelines for the optimal care of military traumatic injuries. One of the clinical sites participating in METRC is the University of Maryland Medical Center R Adams Cowley Shock Trauma Center, led by orthopaedic surgeons Andrew N. Pollack, MD, and Robert V. O'Toole, MD, MSME.

"DOD was specifically looking for grant proposals that resulted in clinical practice guidelines and appropriate use criteria related to combat and civilian trauma patients," explained David S. Jevsevar, MD, MBA, chair of the AAOS Council on Research and Quality. "They reached out to AAOS because of our recognized expertise and history of creating comprehensive and well-done clinical practice guidelines."

The grant will be used to develop and disseminate CPGs and AUCs in the following areas:

• Diagnosis and treatment of acute compartment syndrome
• Decision support for optimal clinical intervention following major lower limb trauma in determining limb salvage or early limb amputation
• Early screening for psychosocial risk and protective factors
• Use of multimodal pharmacologic pain management in the perioperative period for patients with orthopaedic trauma
• Techniques for performing a transtibial amputation, eg, surgical formation of a distal end tibia to fibula synostosis
• Prevention and treatment of surgical site infection following major extremity trauma

"Trauma-related injury topics specified by DOD are areas where significant variation in care exists," said Dr. Jevsevar. "The purpose of this grant funding is to determine, through an evidence-based process, the best practice methods for dealing with traumatic extremity injuries. The resultant CPGs and AUCs should help improve outcomes with less variation in care. This understanding will also have a positive effect on treatment for civilian traumatic events such as motor vehicle accidents."

According to Dr. Jevsevar, the grant affirms the ongoing work of AAOS and legitimizes the processes that the AAOS CPG and AUC groups have created. In addition, the external funding will help reduce the burden on AAOS of the costly development process, while maintaining the infrastructure and in-house expertise needed to carry the work forward.

"The AAOS mission statement is 'Serving our profession to provide the highest quality musculoskeletal care,'" noted Dr. Jevsevar. "To achieve this goal, AAOS supports, and is an integral part of, research initiatives that lead to improved care. Research funding for musculoskeletal disease is abysmally small, and the Academy uses its research expertise through the Council on Research and Quality to develop, support, and advocate for orthopaedic research initiatives."

Additional Information:

• AAOS CPGs
• AAOS AUCs
• METRC
• METRC clinical sites