Cohen Steven P, Nguyen Conner, Kapoor Shruti G, Anderson-Barnes Victoria C, Foster Leslie, Shields Cynthia, McLean Brian, Wichman Todd, Plunkett Anthony
Department of Anesthesiology, Johns Hopkins School of Medicine, 550 N Broadway, Ste 301, Baltimore, MD 21029. USA.
Arch Intern Med. 2009 Nov 9;169(20):1916-23. doi: 10.1001/archinternmed.2009.380.
Back pain is the leading cause of disability in the world, but it is even more common in soldiers deployed for combat operations. Aside from battle injuries and psychiatric conditions, spine pain and other musculoskeletal conditions are associated with the lowest return-to-unit rate among service members medically evacuated out of Operations Iraqi and Enduring Freedom.
Demographic, military-specific, and outcome data were prospectively collected over a 2-week period at the Deployed Warrior Medical Management Center in Germany on 1410 consecutive soldiers medically evacuated out of theaters of combat operations for a primary diagnosis pertaining to back pain between 2004 and 2007. The 2-week period represents the maximal allowable time an evacuated soldier can spend in treatment before disposition (ie, return to theater or evacuate to United States) is rendered. Electronic medical records were then reviewed to examine the effect a host of demographic and clinical variables had on the categorical outcome measure, return to unit.
The overall return-to-unit rate was 13%. Factors associated with a positive outcome included female sex, deployment to Afghanistan, being an officer, and a history of back pain. Trends toward not returning to duty were found for navy and marine service members, coexisting psychiatric morbidity, and not being seen in a pain clinic.
The likelihood of a service member medically evacuated out of theater with back pain returning to duty is low irrespective of any intervention(s) or characteristic(s). More research is needed to determine whether concomitant treatment of coexisting psychological factors and early treatment "in theater" can reduce attrition rates.
背痛是全球致残的主要原因，但在执行战斗任务的士兵中更为常见。除战伤和精神疾病外，脊柱疼痛和其他肌肉骨骼疾病是从伊拉克行动和持久自由行动中被医疗后送的军人中返回部队率最低的原因。
2004年至2007年期间，在德国的部署战士医疗管理中心，对连续1410名因背痛的初步诊断而从战斗行动战区被医疗后送的士兵，在两周时间内前瞻性收集人口统计学、军事特定和结果数据。这两周时间代表了一名后送士兵在做出处置（即返回战区或撤离到美国）之前可用于治疗的最长允许时间。然后审查电子病历，以检查一系列人口统计学和临床变量对分类结果指标“返回部队”的影响。
总体返回部队率为13%。与积极结果相关的因素包括女性、部署到阿富汗、军官身份以及背痛史。发现海军和海军陆战队成员、并存精神疾病以及未在疼痛诊所就诊的人员有不返回部队的趋势。
因背痛从战区被医疗后送的军人返回部队的可能性很低，无论采取何种干预措施或具备何种特征。需要更多研究来确定同时治疗并存的心理因素以及在“战区”进行早期治疗是否可以降低损耗率。
