Sulsky Sandra I, Bulzacchelli Maria T, Zhu Lei, Karlsson Lee, McKinnon Craig J, Hill Owen T, Kardouni Joseph R
Ramboll Environ US Corporation, 28 Amity Street, Amherst, MA 010012.
University of Massachusetts, School of Public Health and Health Sciences, 106 Arnold House, Amherst, MA 01003.
Mil Med. 2018 Mar 1;183(suppl_1):55-65. doi: 10.1093/milmed/usx147.
Injuries during basic combat training (BCT) impact military health and readiness in the U.S. Army. Identifying risk factors is crucial for injury prevention, but few Army-wide studies to identify risk factors for injury during BCT have been completed to date. This study examines associations between individual and training-related characteristics and injuries during Army BCT.
Using administrative data from the Total Army Injury and Health Outcomes Database (TAIHOD), we identified individuals who apparently entered BCT for the first time between 1 January 2002 and 30 September 2007, based on review of administrative records. Injuries were identified and categorized based on coded medical encounter data. When combined with dates of medical services, we could count injuries per person, identify unique injuries, and identify the quantity and type of medical care delivered. Regression models produced odds ratios (ORs) and 95% confidence intervals (CIs) to identify risk factors for injury during BCT (yes/no), adjusted for potential confounders.
Of the 278,045 (83.4%) men and 55,302 (16.6%) women who were apparently first-time trainees, 39.5% (n = 109,760) of men and 60.9% (n = 33,699) of women were injured during training based on over 2 million recorded medical encounters entries. The large cohort yielded statistically significant, small magnitude associations between injury and all individual and training-related covariates for men, and all but medical accession waivers and weight for women. After adjustment, largest magnitude effects among men were due to age > 25 yr vs. 17-18 yr (OR = 1.83, 95% CI: 1.75, 1.91); having been married in the past vs. being single (OR = 1.36, 95% CI: 1.24, 1.49); rank E4-E7 vs. E1 (OR = 0.56, 95% CI: 0.53. 0.59); training at Ft. Jackson (OR = 0.66, 95% CI: 0.64, 0.69), Ft. Leonard Wood (OR = 0.67, 95% CI: 0.65, 0.70), or Ft. Knox (OR = 0.69, 95% CI: 066, 0.72) vs. Ft. Benning. Odds of injury were highest during 2005, 2006, and 2007. After adjustment for weight and body mass index, taller men had higher odds of BCT injury than average height men (OR = 1.08, 95% CI: 1.05, 1.11). Among women, short stature (OR = 1.11; 95% CI: 1.04, 1.19), training at Ft Leonard Wood (OR = 1.10; 95% CI: 1.04, 1.16) and evidence of injury prior to training based on accession waiver (OR = 1.12; 95% CI: 1.00, 1.26) increased injury risk.
This Army-wide analysis reveals higher BCT-related injury rates for both men and women than prior studies and identifies risk factors for injuries during BCT. The large data set allows adjustment for many covariates, but because statistical analysis may yield significant findings for small differences, results must be interpreted based on minimally important differences determined by military and medical professionals. Results provide information that may be used to adapt training or medical screening and examination procedures for basic trainees.
基础战斗训练（BCT）期间的受伤情况会影响美国陆军的军人健康及战备状态。识别风险因素对于预防受伤至关重要，但迄今为止，很少有全军范围的研究来确定BCT期间受伤的风险因素。本研究探讨了陆军BCT期间个人特征、训练相关特征与受伤情况之间的关联。
我们使用陆军伤病与健康结果数据库（TAIHOD）中的管理数据，通过审查管理记录，确定了2002年1月1日至2007年9月30日期间首次参加BCT的人员。根据编码的医疗就诊数据识别并分类受伤情况。结合医疗服务日期，我们可以计算每人的受伤次数，识别独特的损伤，并确定所提供医疗护理的数量和类型。回归模型得出比值比（OR）和95%置信区间（CI），以确定BCT期间受伤（是/否）的风险因素，并对潜在混杂因素进行了调整。
在278,045名（83.4%）男性和55,302名（16.6%）女性这一明显为首次参训人员的群体中，根据超过200万条记录的医疗就诊记录，39.5%（n = 109,760）的男性和60.9%（n = 33,699）的女性在训练期间受伤。这个大样本队列得出了在男性中，受伤与所有个人及训练相关协变量之间具有统计学意义的、较小程度的关联，在女性中，除了医疗入伍豁免和体重外，与所有协变量也有类似关联。调整后，男性中影响程度最大的因素包括年龄大于25岁与17 - 18岁相比（OR = 1.83，95% CI：1.75，1.91）；过去已婚与单身相比（OR = 1.36，95% CI：1.24，1.49）；军衔E4 - E7与E1相比（OR = 0.56，95% CI：0.53，0.59）；在杰克逊堡训练（OR = 0.66，95% CI：0.64，0.69）、伦纳德·伍德堡训练（OR = 0.67，95% CI：0.65，0.70）或诺克斯堡训练（OR = 0.69，95% CI：066，0.72）与在本宁堡训练相比。受伤几率在2005年、2006年和2007年最高。在对体重和体重指数进行调整后，身材较高的男性BCT受伤几率高于平均身高男性（OR = 1.08，95% CI：1.05，1.11）。在女性中，身材矮小（OR = 1.11；95% CI：1.04，1.19）、在伦纳德·伍德堡训练（OR = 1.10；95% CI：1.04，1.16）以及基于入伍豁免显示训练前有受伤史（OR = 1.12；95% CI：1.00，1.26）会增加受伤风险。
这项全军范围的分析显示，男性和女性与BCT相关的受伤率均高于先前研究，并确定了BCT期间受伤的风险因素。这个大数据库允许对许多协变量进行调整，但由于统计分析可能会因微小差异得出显著结果，因此必须根据军事和医学专业人员确定的最小重要差异来解释结果。研究结果提供了可用于调整基础受训人员训练或医疗筛查及检查程序的信息。
