Vascular Surgery Service, Brooke Army Medical Center, JBSA Ft. Sam Houston, San Antonio, TX.
Department of Surgery, Uniformed Services University, Bethesda, MD.
Mil Med. 2020 Aug 14;185(7-8):e1073-e1076. doi: 10.1093/milmed/usz481.
The impact of disease and nonbattle injury (DNBI) on casualty burden of military operations has historically been greater than that of battle-related injuries. The ratio of battle to DNBI casualties has changed as advances in equipment, hygiene, and infectious diseases have been made; however, during military operations in Iraq and Afghanistan, 30% of serious injuries treated or evacuated from the area of operations were secondary to NBI. Most DoD research and intervention efforts focus on battle injuries; NBI has received much less practical attention. We aimed to explore the potential utility of the largest Department of Defense casualty database in identifying potential intervention targets for preventing NBI events.
Phase I was a comprehensive NBI literature review from historical and current military operations. Phase II was an IRB exempt initial examination of relevant data contained in the Department of Defense Trauma Registry (DoDTR). Phase I: A MEDLINE search using the terms "military", "injury", and "nonbattle/non battle" was performed, and articles containing useful data points to characterize the unique risks of the modern deployed military environment and identify potentially preventable NBI hazards in the modern deployed military environment were retrieved and reviewed in full-text. Phase II: This information was used to explore data within the DoDTR's and its ability to provide data to inform NBI prevention efforts in the following areas: most prevalent NBI causes, NBI location and timing related to operational tempo, characteristics of the population at risk for NBI.
Phase I: Falls and motor vehicle crashes (MVCs) accounted for most of the serious NBI in Iraq and Afghanistan. No specific epidemiologic data was readily available to guide NBI prevention efforts. Phase II was limited to NBI and falls from Iraq and Afghanistan in the DoDTR. Only aggregate data were available with a total of 1829 falls and 1899 MVCs. Case fatality for falls was 1.1% and for MVCs 6.5%. The greatest frequency of NBI was in Iraq among U.S. Army personnel, but comparison of rates is not possible without reliable denominators for individual variables. Annual NBI incidence seems proportional to overall level of personnel deployed to each theater, but without knowledge of the true denominator of total deployed personnel, it is impossible to conclude definitively. The annual number of falls was stable throughout the period of highest operational tempo in Iraq (2003-2011), although MVCs were more common earlier in the operation (2003-2005), likely corresponding to greater operational maneuver.
The deployed military environment is dangerous and NBI presents a primary prevention target for expeditionary operations. The DoDTR is a database of detailed injury and medical care information and lacks much of the data required to perform a comprehensive epidemiologic NBI analysis. Specific prevention recommendations cannot be made based solely on DoDTR data and integration with other DoD databases that assess operational and tactical data should be considered.
疾病和非战斗性损伤（DNBI）对军事行动伤员负担的影响历来大于战斗相关损伤。随着设备、卫生和传染病方面的进步，战斗相关与非战斗相关损伤的伤员比例发生了变化；然而，在伊拉克和阿富汗的军事行动中，从行动区治疗或后送的 30%严重伤员是由非战斗性损伤导致的。大多数国防部的研究和干预措施都集中在战斗损伤上；非战斗性损伤受到的实际关注要少得多。我们旨在探索最大的国防部伤员数据库在确定预防非战斗性损伤事件的潜在干预目标方面的潜在效用。
第一阶段是对历史和当前军事行动中非战斗性损伤的全面文献综述。第二阶段是对国防部创伤登记处（DoDTR）中相关数据的 IRB 豁免初步检查。第一阶段：使用“军事”、“损伤”和“非战斗/非战斗”等术语进行了 MEDLINE 搜索，并检索了包含有助于描述现代部署军事环境中独特风险以及识别现代部署军事环境中潜在可预防的非战斗性损伤危害的有用数据点的文章，并全文审查了这些文章。第二阶段：利用这些信息探索了 DoDTR 中的数据及其提供信息以指导非战斗性损伤预防工作的能力，这些信息包括：最常见的非战斗性损伤原因、与行动节奏相关的非战斗性损伤位置和时间、高危人群的特征。
第一阶段：在伊拉克和阿富汗，坠落伤和机动车事故（MVC）是非战斗性严重损伤的主要原因。没有现成的特定流行病学数据来指导非战斗性损伤预防工作。第二阶段仅限于 DoDTR 中的非战斗性损伤和从伊拉克和阿富汗发生的坠落伤。只有总计 1829 例坠落伤和 1899 例 MVC 的汇总数据可用。坠落伤的病死率为 1.1%，MVC 为 6.5%。非战斗性损伤的发生率在伊拉克的美国陆军人员中最高，但如果没有用于个别变量的可靠分母，就无法比较发生率。非战斗性损伤的年发生率似乎与每个战区部署的人员总数成正比，但由于不知道部署人员的真实分母，因此无法明确得出结论。在伊拉克行动节奏最高的整个期间，坠落伤的年发生率保持稳定（2003-2011 年），尽管 MVC 更早出现（2003-2005 年），可能与更大的行动机动性有关。
部署的军事环境是危险的，非战斗性损伤是远征行动的主要预防目标。国防部创伤登记处是一个详细的损伤和医疗信息数据库，但缺乏进行全面的非战斗性损伤流行病学分析所需的大部分数据。不能仅根据国防部创伤登记处的数据提出具体的预防建议，应考虑与评估行动和战术数据的其他国防部数据库进行整合。
