Garber Bryan G, Rusu Corneliu, Zamorski Mark A, Boulos David
Canadian Forces Health Services Group Headquarters, Ottawa, Ontario, Canada.
Canadian Forces Health Services Group Headquarters, Ottawa, Ontario, Canada Faculty of Medicine, Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
BMJ Open. 2016 May 4;6(5):e010780. doi: 10.1136/bmjopen-2015-010780.
Deployment-related mild traumatic brain injury (MTBI) occurs in a significant number of military personnel but its long-term impacts are unclear. This study explores the impact of deployment-related MTBI on continued fitness-for-duty, with the ultimate intent of identifying potential targets for intervention to attenuate its effects.
Consisted of 16 193 Canadian Armed Forces (CAF) personnel who deployed in support of the mission in Afghanistan and completed an enhanced postdeployment screening (EPDS) questionnaire over the period January 2009-July 2012.
The primary outcome was development of permanent medical unfitness defined as a 'career-limiting medical condition' (CL-MC). The secondary outcome was the diagnostic categories recorded for each individual at the time a CL-MC was established.
This study used a retrospective cohort design. Linked administrative and health data provided the primary outcome and the diagnoses responsible for it. Survival analysis was used to estimate the risk of a CL-MC and Cox regression provided adjusted HRs (aHRs) for the association between a CL-MC and MTBI, accounting for key covariates and confounders. Diagnostic categories associated with CL-MCs were identified.
Over a median follow-up period of 3.42 years, 6.57% of the study population developed a CL-MC. MTBI was independently associated with CL-MCs (aHR=1.65, 95% CI 1.35 to 2.03). Mental disorders and musculoskeletal conditions were the primary diagnoses associated with CL-MCs (identified as the primary diagnosis in 55.4% and 25.9%, respectively), and a neurological condition was only documented in 5.8% of those with MTBI who developed a CL-MC CONCLUSIONS: Deployment-related MTBI was associated with adverse occupational outcome but mental disorders and musculoskeletal conditions primarily drove subsequent medical unfitness. These findings support a diagnostic and treatment approach focusing on these comorbidities as the most promising strategy to minimise the burden of disability in MTBI-exposed military personnel.
与部署相关的轻度创伤性脑损伤（MTBI）在大量军事人员中发生，但其长期影响尚不清楚。本研究探讨与部署相关的MTBI对持续胜任工作能力的影响，最终目的是确定潜在的干预靶点以减轻其影响。
由16193名加拿大武装部队（CAF）人员组成，他们部署到阿富汗执行任务，并在2009年1月至2012年7月期间完成了强化部署后筛查（EPDS）问卷。
主要结局是发展为永久性医学上不适宜服役，定义为“限制职业的医学状况”（CL-MC）。次要结局是在确定CL-MC时为每个个体记录的诊断类别。
本研究采用回顾性队列设计。关联的行政和健康数据提供了主要结局及其相关诊断。生存分析用于估计CL-MC的风险，Cox回归提供了CL-MC与MTBI之间关联的调整后风险比（aHRs），同时考虑了关键协变量和混杂因素。确定了与CL-MC相关的诊断类别。
在中位随访期3.42年期间，6.57%的研究人群发展为CL-MC。MTBI与CL-MC独立相关（aHR=1.65，95%CI 1.35至2.03）。精神障碍和肌肉骨骼疾病是与CL-MC相关的主要诊断（分别在55.4%和25.9%的病例中被确定为主要诊断），并且在发展为CL-MC的MTBI患者中，只有5.8%记录有神经系统疾病。结论：与部署相关的MTBI与不良职业结局相关，但精神障碍和肌肉骨骼疾病是导致后续医学上不适宜服役的主要原因。这些发现支持一种以这些合并症为重点的诊断和治疗方法，作为减轻MTBI暴露军事人员残疾负担的最有前景的策略。
