Rivera Jessica C, Hylden Christina M, Johnson Anthony E
US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, USA,
Clin Orthop Relat Res. 2015 Aug;473(8):2448-54. doi: 10.1007/s11999-015-4180-6.
Civilian trauma literature suggests sexual dimorphism in outcomes after trauma. Because women represent an increasing demographic among veterans, the question remains if war trauma outcomes, like civilian trauma outcomes, differ between genders.
QUESTIONS/PURPOSES: (1) Do women service members develop different conditions resulting in long-term disability compared with men service members after injuries sustained during deployment? (2) Do women service members have more or less severe disability after deployment injury compared with men service members? (3) Are men or women more likely to return to duty after combat injury?
The Department of Defense Trauma Registry was queried for women injured during deployment from 2001 to 2011. The subjects were then queried in the Physical Evaluation Board database to determine each subject's return-to-duty status and what disabling conditions and disability percentages were assigned to those who did not return to duty. Frequency of disabling conditions, disability percentages, and return-to-duty rates for 368 women were compared with a previously published cohort of 450 men service members, 378 of whom had orthopaedic injuries.
Women who were unable to return to duty had a higher frequency of arthritic conditions (58% [48 of 83] of women versus 35% [133 of 378] of men, p=0.002; relative risk [RR], 1.64; 95% confidence interval [CI], 1.307-2.067) and lower frequencies of general chronic pain (1% [one of 83] of women versus 19% [59 of 378] of men, p<0.001; RR, 0.08; 95% CI, 0.011-0.549) and neurogenic pain disorders (1% [one of 83] of women versus 7% [27 of 378] of men, p=0.0410; RR, 0.169; 95% CI, 0.023-1.224). Women had more severely rated posttraumatic stress disorder (PTSD) compared with men (38%±23% versus 19%±17%). Forty-eight percent (64 of 133) of battle-injured women were unable to return to active duty, resulting in a lower return-to-duty rate compared with men (34% [450 of 1333]; p=0.003).
After deployment-related injury, women have higher rates of arthritis, lower rates of pain disorders, and more severely rated PTSD compared with men. Women are unable to return to duty more often than men injured in combat. These results suggest some difference between men's and women's outcomes after deployment injury, important information for military and Veterans Administration providers seeking to minimize postdeployment disability.
Level III, prognostic study.
平民创伤文献表明创伤后结果存在性别差异。由于女性在退伍军人中的人口比例不断增加，战争创伤结果是否像平民创伤结果一样存在性别差异仍是个问题。
问题/目的：（1）与男性服役人员相比，女性服役人员在部署期间受伤后是否会出现导致长期残疾的不同病症？（2）与男性服役人员相比，女性服役人员在部署受伤后残疾程度是更严重还是更轻？（3）男性还是女性在战斗受伤后更有可能重返岗位？
查询国防部创伤登记处2001年至2011年期间部署期间受伤的女性。然后在体格评估委员会数据库中查询这些受试者，以确定每个受试者的重返岗位状态，以及那些未重返岗位者被认定的致残病症和残疾百分比。将368名女性的致残病症频率、残疾百分比和重返岗位率与先前发表的450名男性服役人员队列进行比较，其中378名男性有骨科损伤。
无法重返岗位的女性患关节炎的频率更高（女性为58%[83人中的48人]，男性为35%[378人中的133人]；p=0.002；相对风险[RR]为1.64；95%置信区间[CI]为1.307 - 2.067），而一般慢性疼痛（女性为1%[83人中的1人]，男性为19%[378人中的59人]；p<0.001；RR为0.08；95%CI为0.011 - 0.549）和神经源性疼痛障碍（女性为1%[83人中的1人]，男性为7%[378人中的27人]；p=0.0410；RR为0.169；95%CI为0.023 - 1.224）的频率更低。与男性相比，女性创伤后应激障碍（PTSD）的严重程度更高（38%±23%对19%±17%）。48%（133人中的64人）战斗受伤的女性无法重返现役，导致重返岗位率低于男性（34%[1333人中的450人]；p=0.003）。
与男性相比，部署相关受伤后，女性患关节炎的比例更高，疼痛障碍的比例更低，PTSD的严重程度更高。女性比战斗受伤的男性更常无法重返岗位。这些结果表明部署受伤后男性和女性的结果存在一些差异，这对寻求将部署后残疾降至最低的军事和退伍军人管理局医疗人员来说是重要信息。
三级，预后研究。
