Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.
Leidos, Inc., 140 Sylvester Road, San Diego, CA, 92106, USA.
BMC Public Health. 2020 Apr 28;20(1):578. doi: 10.1186/s12889-020-08696-4.
Blast injury emerged as a primary source of morbidity among US military personnel during the recent conflicts in Iraq and Afghanistan, and led to an array of adverse health outcomes. Multimorbidity, or the presence of two or more medical conditions in an individual, can complicate treatment strategies. To date, there is minimal research on the impact of multimorbidity on long-term patient-reported outcomes. We aimed to define multimorbidity patterns in a population of blast-injured military personnel, and to examine these patterns in relation to long-term quality of life (QOL).
A total of 1972 US military personnel who sustained a blast-related injury during military operations in Iraq and Afghanistan were identified from clinical records. Electronic health databases were used to identify medical diagnoses within the first year postinjury, and QOL was measured with a web-based assessment. Hierarchical cluster analysis methods using Ward's minimum variance were employed to identify clusters with related medical diagnosis categories. Duncan's multiple range test was used to group clusters into domains by QOL.
Five distinct clusters were identified and grouped into three QOL domains. The lowest QOL domain contained one cluster with a clinical triad reflecting musculoskeletal pain, concussion, and mental health morbidity. The middle QOL domain had two clusters, one with concussion/anxiety predominating and the other with polytrauma. The highest QOL domain had two clusters with little multimorbidity aside from musculoskeletal pain.
The present study described blast-related injury profiles with varying QOL levels that may indicate the need for integrated health services. Implications exist for current multidisciplinary care of wounded active duty and veteran service members, and future research should determine whether multimorbidity denotes distinct post-blast injury syndromes.
在最近的伊拉克和阿富汗冲突中，爆炸伤成为美国军事人员发病的主要原因，并导致一系列不良健康后果。多种疾病，即在个体中存在两种或多种医疗状况，会使治疗策略变得复杂。迄今为止，关于多种疾病对长期患者报告结果的影响的研究很少。我们旨在确定爆炸伤军人人群中的多种疾病模式，并研究这些模式与长期生活质量（QOL）的关系。
从临床记录中确定了 1972 名在美国军事行动中因爆炸伤而受伤的美国军事人员。电子健康数据库用于在受伤后一年内识别医疗诊断，并且使用基于网络的评估来衡量 QOL。使用 Ward 的最小方差分层聚类分析方法来识别具有相关医疗诊断类别的聚类。使用 Duncan 多重范围检验将聚类按 QOL 分为域。
确定了五个不同的聚类，并分为三个 QOL 域。最低 QOL 域包含一个反映肌肉骨骼疼痛、脑震荡和心理健康发病率的临床三联征的聚类。中间 QOL 域有两个聚类，一个以脑震荡/焦虑为主，另一个以多发性创伤为主。最高 QOL 域有两个聚类，除了肌肉骨骼疼痛外，其他疾病的发病率很低。
本研究描述了具有不同 QOL 水平的爆炸相关损伤特征，这可能表明需要综合健康服务。这对现役和退伍军人的多学科护理有影响，未来的研究应该确定多种疾病是否表示不同的爆炸伤后综合征。
