Novartis Vaccines and Diagnostics, Washington, DC, USA.
Am J Prev Med. 2010 Jan;38(1 Suppl):S19-33. doi: 10.1016/j.amepre.2009.10.004.
Injuries, one of the leading public health problems in an otherwise healthy military population, affect operational readiness, increase healthcare costs, and result in disabilities and fatalities. This paper describes a systematic, data-driven, injury prevention-decision making process to rank potential injury prevention targets.
Medical surveillance and safety report data on injuries for 2004 were reviewed. Nonfatal injury diagnoses (ICD-9-CM codes) obtained from the Defense Medical Surveillance System were ranked according to incident visit frequency and estimated limited duty days. Data on the top five injury types resulting in the greatest estimated limited duty days were matched with hospitalization and Service Safety Centers' accident investigation data to identify leading causes. Experts scored and ranked the causes using predetermined criteria that considered the importance of the problem, preventability, feasibility, timeliness of intervention establishment/results, and ability to evaluate. Department of Defense (DoD) and Service-specific injury prevention priorities were identified.
Unintentional injuries lead all other medical conditions for number of medical encounters, individuals affected, and hospital bed days. The top ten injuries resulted in an estimated 25 million days of limited duty. Injury-related musculoskeletal conditions were a leading contributor to days of limited duty. Sports and physical training were the leading cause, followed by falls.
A systematic approach to injury prevention-decision making supports the DoD's goal of ensuring a healthy, fit force. The methodology described here advances this capability. Immediate follow-up efforts should employ both medical and safety data sets to identify and monitor injury prevention priorities.
在一个健康的军人群体中，伤害是主要的公共卫生问题之一，它会影响作战准备，增加医疗保健成本，并导致残疾和死亡。本文描述了一个系统的、数据驱动的、伤害预防决策过程，用于对潜在的伤害预防目标进行排名。
对 2004 年的医疗监测和安全报告中的伤害数据进行了回顾。从国防医疗监测系统中获得的非致命性伤害诊断（ICD-9-CM 代码）根据就诊频率和估计的有限责任天数进行了排名。导致最大估计有限责任天数的前五种伤害类型的数据与住院和服务安全中心的事故调查数据相匹配，以确定主要原因。专家根据预先确定的标准对这些原因进行评分和排名，这些标准考虑了问题的重要性、可预防程度、实施/结果的可行性、干预措施的及时性以及评估能力。确定了国防部（DoD）和各军种特定的伤害预防优先事项。
非故意伤害在就诊人数、受影响个体和住院天数方面均超过其他所有医疗状况。前十大伤害导致估计有 2500 万人需要有限责任。与伤害相关的肌肉骨骼状况是导致有限责任天数的主要原因。运动和体能训练是主要原因，其次是跌倒。
一种系统的伤害预防决策方法支持了确保健康、适应力强的军队的目标。本文描述的方法提高了这一能力。后续的跟进工作应同时利用医疗和安全数据集来确定和监测伤害预防的优先事项。
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