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Military Health System

Our History

Military medicine has a long and celebrated history. We apply lessons from our past to improve the care of military personnel and their families today and in the future. New surgical techniques, powerful painkillers, antibiotic drugs, and triage and evacuation procedures have revolutionized military medicine.

In this section, you'll find featured stories and information about the history of military medicine.

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Sudden cardiac death associated with physical exertion in the US military, 2005-2010.

Study

Abstract

BACKGROUND: Sudden cardiac death associated with physical exertion (SCD/E) is a complicated pathophysiological event. This study aims to calculate the incidence rate of SCD/E in the US military population from 2005 to 2010, to characterise the demographic and cardiovascular risk profiles of decedents, and to evaluate aetiologies of and circumstances surrounding the deaths. METHODS: Perimortem and other relevant data were collected from the Armed Forces Medical Examiners Tracking System, Armed Forces Health Longitudinal Technology Application, and Defense Medical Epidemiology Database for decedents meeting SCD/E case definition. Incidence rates were calculated and compared using negative binomial regression. RESULTS: The incidence of SCD/E in the Active Component (ie, full-time active duty) US military from 2005 to 2010 was 1.63 per 100 000 person-years (py): 0.98 and 3.84 per 100 000 py in those aged <35 and ≥35 years, respectively. Atherosclerotic cardiovascular disease was the leading cause of death overall (55%) and in the ≥35-year age group (78%), whereas the leading cause of death in the <35-year age group (31%) could not be precisely determined and was termed idiopathic SCD/E (iSCD/E). SCD/E was more common in males than females (incidence rate ratio (IRR) = 5.28, 95% CI 2.16 to 12.93) and more common in blacks than whites (IRR=2.60, 95% CI 1.81 to 3.72). All female cases were black. CONCLUSIONS: From 2005 to 2010, the incidence of SCD/E in US military members aged <35 years was similar to most reported corresponding civilian SCD rates. However, the leading cause of death was iSCD/E and not cardiomyopathy. Improved surveillance and age-based prevention strategies may reduce these rates.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Uniformed Services University of Health Sciences
  • Congressionally Mandated: No
  • Funding Source:
  • Release Date/Publication: January 01, 2016
  • Citation: Smallman DP, Webber BJ, Mazuchowski EL, Scher AI, Jones SO, Cantrell JA. Sudden cardiac death associated with physical exertion in the US military, 2005-2010. Br J Sports Med. 2016 Jan;50(2):118-23.

Stress in Service Members.

Study

Abstract

Military service differs from civilian jobs in the stressors that service members experience, including frequent deployments (eg, to an area of combat operations), obedience, regimentation, subordination of self to the group, integrity, and flexibility. The military culture emphasizes teamwork and peer support. In some cases, service members cannot adapt to military life, become overwhelmed by stress, or cannot overcome a traumatic experience. Clinicians should conduct a thorough evaluation guided by an understanding of the military culture. Every effort should be made to identify the stress and the maladaptive response and provide early clinical interventions to prevent progression.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Walter Reed National Military Medical Center
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: December 01, 2014
  • Citation: Lande RG. Stress in Service Members. Psychiatr Clin North Am. 2014 Dec;37(4):547-560. doi: 10.1016/j.psc.2014.08.007.

Stress and Resilience in Military Mortuary Workers: Care of the Dead From Battlefield to Home.

Study

Abstract

The death of a military service member in war provokes feelings of distress and pride in mortuary workers who process the remains. To further understand their reactions, the authors interviewed 34 military and civilian personnel to learn more about their work stresses and rewards. They review stresses of anticipation, exposure, and experience in handling the dead and explore the personal, supervisory, and leadership strategies to reduce negative effects and promote personal growth. These results can be applied to many other situations requiring planning, implementing, and supervising mortuary operations involving mass death.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Uniformed Services University of Health Sciences
  • Congressionally Mandated: No
  • Funding Source:
  • Release Date/Publication: August 01, 2014
  • Citation: Flynn BW, McCarroll JE, Biggs QM. Stress and Resilience in Military Mortuary Workers: Care of the Dead From Battlefield to Home. Death Stud. 2014 Aug 20:1-7.

Sleep characteristics, mental health, and diabetes risk: a prospective study of U.S. military service members in the Millennium Cohort Study.

Study

Abstract

OBJECTIVE: Research has suggested that a higher risk of type 2 diabetes associated with sleep characteristics exists. However, studies have not thoroughly assessed the potential confounding effects of mental health conditions associated with alterations in sleep. RESEARCH DESIGN AND METHODS: We prospectively assessed the association between sleep characteristics and self-reported incident diabetes among Millennium Cohort Study participants prospectively followed over a 6-year time period. Surveys are administered approximately every 3 years and collect self-reported data on demographics, height, weight, lifestyle, features of military service, sleep, clinician-diagnosed diabetes, and mental health conditions assessed by the PRIME-MD Patient Health Questionnaire and the PTSD Checklist-Civilian Version. Statistical methods for longitudinal data were used for data analysis. RESULTS: We studied 47,093 participants (mean 34.9 years of age; mean BMI 26.0 kg/m2; 25.6% female). During 6 years of follow-up, 871 incident diabetes cases occurred (annual incidence 3.6/1,000 person-years). In univariate analyses, incident diabetes was significantly more likely among participants with self-reported trouble sleeping, sleep duration<6 h, and sleep apnea. Participants reporting incident diabetes were also significantly older, of nonwhite race, of higher BMI, less likely to have been deployed, and more likely to have reported baseline symptoms of panic, anxiety, posttraumatic stress disorder, and depression. After adjusting for covariates, trouble sleeping (odds ratio 1.21 [95% CI 1.03-1.42]) and sleep apnea (1.78 [1.39-2.28]) were significantly and independently related to incident diabetes. CONCLUSIONS: Trouble sleeping and sleep apnea predict diabetes risk independent of mental health conditions and other diabetes risk factors.

  • Publication Status: Published
  • Sponsoring Organization: DoD agency, office, or organization other than the Army, Navy, Air Force, or Defense Health Agency
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source: Agency, office or organization under authority of the Sec Def (not affiliated to Army, Navy, or Air Force)
  • Release Date/Publication: October 01, 2013
  • Citation: Boyko EJ, Seelig AD, Jacobson IG, Hooper TI, Smith B, Smith TC, et. al. Sleep characteristics, mental health, and diabetes risk: a prospective study of U.S. military service members in the Millennium Cohort Study. Diabetes Care. 2013 Oct;36(10):3154-61.

Sleep as a component of the performance triad: the importance of sleep in a military population.

Study

Abstract

OBJECTIVE: Sleep habits among military populations are problematic. Poor sleep hygiene occurs in parallel with the global increase in obesity and metabolic syndrome and contributes to a decrease in performance. The extent of sleep issues needs to be quantified to provide feedback for optimizing warfighter performance and readiness. This study assessed various health behaviors and habits of US Army Soldiers and their relationship with poor sleep quality by introducing a set of new questions into the Comprehensive Soldier and Family Fitness (CSF2) Global Assessment Tool (GAT). METHODS: Subjects included 14,148 US Army Active, Reserve, and National Guard members (83.4% male) who completed the GAT, a self-report questionnaire that measures 4 fitness dimensions: social, family, emotional, and spiritual. Approximately 60 new questions, including ones on sleep quality, within the fifth CSF2 dimension (physical) were also answered. A sleep score was calculated from 2 questions validated in the Pittsburgh Insomnia Rating Scale (0 to 6). RESULTS: Poor sleepers (5-6) were significantly (P<.001) more likely than good sleepers (0-1) to consider themselves in fair or poor health, be overweight or obese, and score in the lowest quartile of the emotional, social, family, and spiritual fitness dimensions. Additionally, poor sleepers were significantly (P<.001) less likely to have a healthy body mass index and waist circumference, eat breakfast 6 or more times a week, meet aerobic exercise and resistance training recommendations, and pass their Army Physical Fitness Test in the top quartile. CONCLUSION: This study examined sleep quality in a group of military personnel and indicated significant associations between quality of sleep and physical performance, nutritional habits, measures of obesity, lifestyle behaviors and measures of psychosocial status. Targeted educational interventions and resources are needed to improve sleep patterns based on behaviors that can be most easily modified.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Uniformed Services University of Health Sciences
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: October 01, 2013
  • Citation: Lentino CV, Purvis DL, Murphy KJ, Deuster PA. Sleep as a component of the performance triad: the importance of sleep in a military population. US Army Med Dep J. 2013 Oct-Dec:98-108

Sexually transmitted infections and sexual behavior of deploying shipboard US military personnel: a cross-sectional analysis.

Study

Abstract

OBJECTIVES: Sexually transmitted infection (STI) prevalence and risk behavior may differ at different phases of deployment. We examined STI prevalence and sexual behavior in the predeployment time period (12 months prior) among recently deployed shipboard US Navy and Marine Corps military personnel. METHODS: Data were collected from 1938 male and 515 female service members through an anonymous, self-completed survey assessing sexual behaviours and STI acquisition characteristics in the past 12 months. Cross-sectional sex-stratified descriptive statistics are reported. RESULTS: Overall, 67% (n=1262/1896) reported last sex with a military beneficiary (spouse, n=931, non-spouse service member, n=331). Among those with a sexual partner outside their primary partnership, 24% (n=90/373) reported using a condom the last time they had sex and 30% (n=72/243) reported their outside partner was a service member. In total, 90% (n=210/233) reported acquiring their most recent STI in the USA (88%, n=126/143 among those reporting ≥1 deployments and an STI ≥1 year ago) and a significantly higher proportion (p<0.01) of women than men acquired the STI from their regular partner (54% vs 21%) and/or a service member (50% vs 26%). CONCLUSIONS: Findings suggest a complex sexual network among service members and military beneficiaries. Findings may extend to other mobile civilian and military populations. Data suggest most STI transmission within the shipboard community may occur in local versus foreign ports but analyses from later time points in deployment are needed. These data may inform more effective STI prevention interventions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Walter Reed National Military Medical Center
  • Congressionally Mandated: No
  • Funding Source: Agency, office or organization under authority of the Sec Def (not affiliated to Army, Navy, or Air Force)
  • Release Date/Publication: December 01, 2015
  • Citation: Harbertson J, Scott PT, Moore J, Wolf M, Morris J, Thrasher S et.al., Sexually transmitted infections and sexual behaviour of deploying shipboard US military personnel: a cross-sectional analysis. Sex Transm Infect. 2015 Dec;91(8):581-8.

Sexual Assault and Sexual Harassment in the U.S. Military Volume 1. Design of the 2014 RAND Military Workplace Study

Study

Abstract

In early 2014, the Department of Defense Sexual Assault Prevention and Response Office asked the RAND National Defense Research Institute to conduct an independent assessment of sexual assault, sexual harassment, and gender discrimination in the military — an assessment last conducted in 2012 by the department itself with its Workplace and Gender Relations Survey of Active Duty Personnel. This volume documents the methodology used in the resulting RAND Military Workplace Study, which invited close to 560,000 service members to participate in a survey fielded in August and September of 2014. It describes the survey methods, how the new questionnaire was designed, and how sampling, recruitment, and analytic weighting were pursued. It also includes the entire survey instrument.

  • Publication Status: Published
  • Sponsoring Organization: DoD agency, office, or organization other than the Army, Navy, Air Force, or Defense Health Agency
  • Sponsoring Office: National Development and Research Institutes, Inc.
  • Congressionally Mandated: No
  • Funding Source: Federally Funded Research and Development Center
  • Release Date/Publication: July 01, 2014
  • Citation: Rand Corporation, National Defense Research Institute

Seroprevalence and seroincidence of herpes simplex virus (2006-2010), syphilis (2006-2010), and vaccine-preventable human papillomavirus subtypes (2000-2010) among US military personnel.

Study

Abstract

BACKGROUND: Sexually transmitted infections have historically been burdensome in military populations. We describe the seroprevalence and seroincidence of vaccine-preventable human papillomavirus (VP-HPV) subtypes in a sample of 200 servicemen, along with the seroprevalence and seroincidence of herpes simplex virus (HSV-1/2) and syphilis in a sample of 200 men and 200 women. METHODS: Sera from 200 men, along with associated demographic data, were obtained and tested for HPV serotypes at service entry and 10 years later. Similarly, 200 active-duty men and 200 active-duty women were tested for HSV-1/2 at entry to service and 4 years later. RESULTS: The baseline prevalence of VP-HPV subtypes was 14.5%, and cumulative seroincidence of new infection was 34% over a 10-year period (n = 68). Of these, 63% (n = 43) represented HPV-6, HPV-11, or both; 18% of new infections were either HPV-16 or HPV-18, and 19% (n = 13) were a mixture of all 4 strains. At entry to military service, 33.5% of men were seropositive for HSV-1 and 1.5% were positive for HSV-2; seroincidence was 3.4 and 1.1 per 100 person-years, respectively. Among women, 39% were seropositive for HSV-1 and 4.0% for HSV-2; seroincidence was 5.5 and 3.3 per 100 person-years, respectively. There were 2 prevalent and 3 incident cases of syphilis. CONCLUSIONS: Sexually transmitted infections in military populations are highly prevalent, incident, and epidemiologically distinct. Our data show the rates of HPV and HSV-1/2 acquisition that are higher than those seen in the general public, again highlighting the need for continued preventive efforts. Consideration of universal HPV vaccination among men is warranted.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Walter Reed National Military Medical Center
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: May 01, 2015
  • Citation: Masel J, et. al., Seroprevalence and seroincidence of herpes simplex virus (2006-2010), syphilis (2006-2010), and vaccine-preventable human papillomavirus subtypes (2000-2010) among US military personnel. Sex Transm Dis. 2015 May;42(5):253-8

Self-reported sexually transmitted infections and sexual risk behaviors in the U.S. Military: how sex influences risk.

Study

Abstract

BACKGROUND: Sexually transmitted infections (STIs) are prevalent in the U.S. military. However, there are limited data on risk-factor differences between sexes. METHODS: We used data from the 2008 Department of Defense Survey of Health Related Behaviors among active duty military personnel to identify risk factors for self-reported STIs within the past 12 months and multiple sexual partners among sexually active unmarried service members. RESULTS: There were 10,250 active duty personnel, mostly white (59.3%) aged 21 to 25 years (42.6%). The prevalence of any reported STI in the past 12 months was 4.2% for men and 6.9% for women. One-fourth of men and 9.3% of women reported 5 or more sexual partners in the past 12 months. Binge drinking, illicit substance use, and unwanted sexual contact were associated with increased report of sexual partners among both sexes. Family/personal-life stress and psychological distress influenced number of partnerships more strongly for women than for men (Adjusted Odds Ratio [AOR]=1.58, 95% Confidence Interval [CI]=1.18-2.12 and AOR=1.41, 95% CI=1.14-1.76, respectively). After adjusting for potential confounders, we found that the report of multiple sexual partners was significantly associated with the report of an STI among men (AOR, 5.87 [95% CI, 3.70-9.31], for ≥5 partners; AOR, 2.35 [95% CI, 1.59-3.49], for 2-4 partners) and women (AOR, 4.78 [95% CI, 2.12-10.80], for ≥5 partners; AOR, 2.35 [95% CI, 1.30-4.25], for 2-4 partners). CONCLUSIONS: Factors associated with the report of increasing sexual partnerships and report of an STI differed by sex. Sex-specific intervention strategies may be most effective in mitigating the factors that influence risky sexual behaviors among military personnel.

  • Publication Status: Published
  • Sponsoring Organization: Undetermined
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source:
  • Release Date/Publication: June 01, 2014
  • Citation: Stahlman S, Javanbakht M, Cochran S, Hamilton AB, Shoptaw S, Gorbach PM. Self-reported sexually transmitted infections and sexual risk behaviors in the U.S. Military: how sex influences risk. Sex Transm Dis. 2014 Jun;41(6):359-64

Self-administration of intranasal influenza vaccine: Immunogenicity and volunteer acceptance. Vaccine. 2015 Jul 31;33(32):3894-9.

Study

Abstract

BACKGROUND: In outbreak settings, mass vaccination strategies could maximize health protection of military personnel. Self-administration of live attenuated influenza vaccine (LAIV) may be a means to vaccinate large numbers of people and achieve deployment readiness while sparing the use of human resources. METHODS: A phase IV, open-label, randomized controlled trial evaluating the immunogenicity and acceptance of self-administered (SA) LAIV was conducted from 2012 to 2014. SA subjects were randomized to either individual self-administration or self-administration in a group setting. Control randomized subjects received healthcare worker-administered (HCWA) LAIV. Anti-hemagglutinin (HAI) antibody concentrations were measured pre- and post-vaccination. The primary endpoint was immunogenicity non-inferiority between SA and HCWA groups. Subjects were surveyed on preferred administration method. RESULTS: A total of 1077 subjects consented and were randomized (529 SA, 548 HCWA). Subject characteristics were very similar between groups, though SA subjects were younger, more likely to be white and on active duty. The per-protocol analysis included 1024 subjects (501 SA, 523 HCWA). Post-vaccination geometric mean titers by vaccine strain and by study group (HCWA vs. SA) were: A/H1N1 (45.8 vs. 48.7, respectively; p=0.43), A/H3N2 (45.5 vs. 46.4; p=0.80), B/Yamagata (17.2 vs. 17.8; p=0.55). Seroresponses to A components were high (∼67%), while seroresponses to B components were lower (∼25%). Seroresponse did not differ by administration method. Baseline preference for administration method was similar between groups, with the majority in each group expressing no preference. At follow-up, the majority (64%) of SA subjects preferred SA vaccine. CONCLUSIONS: LAIV immunogenicity was similar for HCWA and SA vaccines. SA was well-tolerated and preferred to HCWA among those who performed SA.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Walter Reed National Military Medical Center
  • Congressionally Mandated: No
  • Funding Source: Agency, office or organization under authority of the Sec Def (not affiliated to Army, Navy, or Air Force)
  • Release Date/Publication: July 01, 2015
  • Citation: Burgess TH, et. al.,

Risk factors for severe outcomes among members of the United States military hospitalized with pneumonia and influenza, 2000-2012.

Study

Abstract

BACKGROUND: The progression from hospitalization for a respiratory infection to requiring substantial supportive therapy is a key stage of the influenza severity pyramid. Respiratory infections are responsible for 300,000-400,000 medical encounters each year among US military personnel, some of which progress to severe acute respiratory infections. METHODS: We obtained data on 11,086 hospitalizations for pneumonia and influenza (P&I) among non-recruit US military service members during the period of 1 January 2000 through 31 December 2012. From these, we identified 512 P&I hospitalizations that progressed to severe episodes using standard case definitions. We evaluated the effect of demographic and occupational characteristics, co-morbid conditions, and history of influenza vaccination on the risk of a hospitalized P&I case becoming a severe case. We also evaluated the risk of a severe outcome and the length of time since influenza vaccination (within 180, 60, and 30 days). RESULTS: The median age of subjects at the time of the P&I episode was 32 years (range, 28-40) and subjects were predominantly male (89.5%). In a univariate analysis, demographic risk factors for a severe episode included service in the US Air Force (RR=1.6 relative to US Army, 95%CI 1.3-2.1), US Coast Guard (RR=2.1, 1.2-3.7) or US Navy (RR=1.4, 1.1-1.8). Being born in the US and recent influenza vaccination (within 180 days of episode) were protective against developing severe disease. Among co-morbid conditions, univariate risk factors for severe disease included chronic renal or liver disease (RR=4.98, 95%CI 4.1-6.1), diseases of the circulatory system (RR=3.1, 95%CI 2.6-3.7), diabetes mellitus (RR=2.3, 95%CI 1.5-3.6), obesity (RR=1.6, 95%CI 1.2-2.1), cancer (RR=1.6, 95%CI 1.3-2.0), and chronic obstructive pulmonary disease (RR=1.4, 95%CI 1.1-1.7). Although many of the risk factors found to be significant in univariate analysis were no longer significant under a multivariate analysis, receipt of any influenza vaccine within 180 days of episode remained protective (RR=0.81, 95%CI 0.67-0.99), while serving in the US Coast Guard (RR=1.9, 95%CI 1.1-3.4) or US Air Force (RR=1. 5, 95%CI 1.2-2.0), presence of renal or liver disease (RR=3.6, 95%CI 2.9-4.6), and diseases of the circulatory system (RR=2.2, 95%CI 1.8-2.8), remained significantly associated with a higher risk of developing severe disease. CONCLUSIONS: In a large cohort, after adjusting for many possible risk factors, influenza vaccination was protective against severe episodes among P&I hospitalizations. The service-specific (US Coast Guard or US Air Force) increased risk may represent some differences in data (e.g., coding or reporting practices) as opposed to genuine differences in physiological outcome. Our findings suggest that renal and liver disease as well as diseases of the circulatory system may contribute to influenza severity in this population independently of age and other potential comorbidities. These findings provide additional evidence for the prioritization of specific risk groups within the US military for influenza vaccination.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Armed Forces Health Surveillance Center
  • Congressionally Mandated: No
  • Funding Source:
  • Release Date/Publication: December 01, 2015
  • Citation: Van Kerkhove MD, Cooper MJ, Cost AA, Sanchez JL, Riley S. Risk factors for severe outcomes among members of the United States military hospitalized with pneumonia and influenza, 2000-2012. Vaccine. 2015 Dec 8;33(49):6970-6.

Safety, Tolerability, and Compliance with Long-Term Antimalarial Chemoprophylaxis in American Soldiers in Afghanistan.

Study

Abstract

Long-term antimalarial chemoprophylaxis is currently used by deployed U.S. military personnel. Previous small, short-term efficacy studies have shown variable rates of side effects among patients taking various forms of chemoprophylaxis, though reliable safety and tolerability data on long-term use are limited. We conducted a survey of troops returning to Fort Drum, NY following a 12-month deployment to Operation Enduring Freedom, Afghanistan from 2006 to 2007. Of the 2,351 respondents, 95% reported taking at least one form of prophylaxis during their deployment, and 90% were deployed for > 10 months. Compliance with daily doxycycline was poor (60%) compared with 80% with weekly mefloquine (MQ). Adverse events (AEs) were reported by approximately 30% with both MQ and doxycycline, with 10% discontinuing doxycycline compared with 4% of MQ users. Only 6% and 31% of soldiers reported use of bed nets and skin repellents, respectively. Compliance with long-term malaria prophylaxis was poor, and there were substantial tolerability issues based on these anonymous survey results, though fewer with MQ than doxycycline. Given few long-term antimalarial chemoprophylaxis options, there is an unmet medical need for new antimalarials safe for long-term use.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Walter Reed National Military Medical Center
  • Congressionally Mandated: No
  • Funding Source:
  • Release Date/Publication: September 01, 2015
  • Citation: Saunders DL, et. al.,

Risk factors for colostomy in military colorectal trauma: a review of 867 patients.

Study

Abstract

BACKGROUND: Limited data exist examining the use of fecal diversion in combatants from modern armed conflicts. Characterization of factors leading to colostomy creation is an initial step toward optimizing and individualizing combat casualty care. METHODS: A retrospective review of the US Department of Defense Trauma Registry database was performed for all US and coalition troops with colorectal injuries sustained during combat operations in Iraq and Afghanistan over 8 years. Colostomy rate, anatomic injury location, mechanism of injury, demographic data, and initial physiologic parameters were examined. Univariate and multivariate analyses were conducted. RESULTS: We identified 867 coalition military personnel with colorectal injuries. The overall colostomy rate was 37%. Rectal injuries had the highest diversion rate (56%), followed by left-sided (41%) and right-sided (20%) locations (P < .0001). Those with gunshot wounds (GSW) underwent diversion more often than blast injuries (43% vs 31% respectively, P < .0008). Injury Severity Score ≥16 (41% vs 30%; P = .0018) and damage control surgery (DCS; 48.2% vs 31.4%; P < .0001) were associated with higher diversion rates. On multivariate analysis, significant predictors for colostomy creation were injury location: Rectal versus left colon (odds ratio [OR], 2.2), rectal versus right colon (OR, 7.5), left versus right colon (OR, 3.4), GSW (OR, 2.0), ISS ≥ 16 (OR, 1.7), and DCS (OR, 1.6). CONCLUSION: In this exploratory study of 320 combat-related colostomies, distal colon and rectal injuries continue to be diverted at higher rates independent of other comorbidities. Additional outcomes-directed research is needed to determine whether such operative management is beneficial in all patients

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Uniformed Services University of Health Sciences
  • Congressionally Mandated: No
  • Funding Source: Army
  • Release Date/Publication: June 01, 2014
  • Citation: Watson JD, Aden JK, Engel JE, Rasmussen TE, Glasgow SC. Risk factors for colostomy in military colorectal trauma: a review of 867 patients. Surgery. 2014 Jun;155(6):1052-61.

Retrospective Analysis of Long-Term Outcomes After Combat Injury: A Hidden Cost of War.

Study

Abstract

BACKGROUND: During the conflicts in Iraq and Afghanistan, 52 087 service members have been wounded in combat. The long-term sequelae of these injuries have not been carefully examined. We sought to determine the relation between markers of injury severity and the subsequent development of hypertension, coronary artery disease, diabetes mellitus, and chronic kidney disease. METHODS AND RESULTS: Retrospective cohort study of critically injured US military personnel wounded in Iraq or Afghanistan from February 1, 2002 to February 1, 2011. Patients were then followed until January 18, 2013. Chronic disease outcomes were assessed by International Classification of Diseases, 9th edition codes and causes of death were confirmed by autopsy. From 6011 admissions, records were excluded because of missing data or if they were for an individual's second admission. Patients with a disease diagnosis of interest before the injury date were also excluded, yielding a cohort of 3846 subjects for analysis. After adjustment for other factors, each 5-point increment in the injury severity score was associated with a 6%, 13%, 13%, and 15% increase in incidence rates of hypertension, coronary artery disease, diabetes mellitus, and chronic kidney disease, respectively. Acute kidney injury was associated with a 66% increase in rates of hypertension and nearly 5-fold increase in rates of chronic kidney disease. CONCLUSIONS: In Iraq and Afghanistan veterans, the severity of combat injury was associated with the subsequent development of hypertension, coronary artery disease, diabetes mellitus, and chronic kidney disease.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Uniformed Services University of Health Sciences
  • Congressionally Mandated: No
  • Funding Source:
  • Release Date/Publication: December 01, 2015
  • Citation: Stewart IJ, Sosnov JA, Howard JT, Orman JA, Fang R, Morrow BD, Zonies DH, Bollinger M, Tuman C, Freedman BA, Chung KK. Retrospective Analysis of Long-Term Outcomes After Combat Injury: A Hidden Cost of War. Circulation. 2015 Dec 1;132(22):2126-33.

Risk factors associated with suicide in current and former US military personnel.

Study

Abstract

IMPORTANCE: Beginning in 2005, the incidence of suicide deaths in the US military began to sharply increase. Unique stressors, such as combat deployments, have been assumed to underlie the increasing incidence. Previous military suicide studies, however, have relied on case series and cross-sectional investigations and have not linked data during service with postservice periods. OBJECTIVE: To prospectively identify and quantify risk factors associated with suicide in current and former US military personnel including demographic, military, mental health, behavioral, and deployment characteristics. DESIGN, SETTING, AND PARTICIPANTS: Prospective longitudinal study with accrual and assessment of participants in 2001, 2004, and 2007. Questionnaire data were linked with the National Death Index and the Department of Defense Medical Mortality Registry through December 31, 2008. Participants were current and former US military personnel from all service branches, including active and Reserve/National Guard, who were included in the Millennium Cohort Study (N = 151,560). MAIN OUTCOMES AND MEASURES: Death by suicide captured by the National Death Index and the Department of Defense Medical Mortality Registry. RESULTS: Through the end of 2008, findings were 83 suicides in 707,493 person-years of follow-up (11.73/100,000 person-years [95% CI, 9.21-14.26]). In Cox models adjusted for age and sex, factors significantly associated with increased risk of suicide included male sex, depression, manic-depressive disorder, heavy or binge drinking, and alcohol-related problems. None of the deployment-related factors (combat experience, cumulative days deployed, or number of deployments) were associated with increased suicide risk in any of the models. In multivariable Cox models, individuals with increased risk for suicide were men (hazard ratio [HR], 2.14; 95% CI, 1.17-3.92; P = .01; attributable risk [AR], 3.5 cases/10,000 persons), and those with depression (HR, 1.96; 95% CI, 1.05-3.64; P = .03; AR, 6.9/10,000 persons), manic-depressive disorder (HR, 4.35; 95% CI, 1.56-12.09; P = .005; AR, 35.6/10,000 persons), or alcohol-related problems (HR, 2.56; 95% CI, 1.56-4.18; P <.001; AR, 7.7/10,000 persons). A nested, matched case-control analysis using 20:1 control participants per case confirmed these findings. CONCLUSIONS AND RELEVANCE: In this sample of current and former military personnel observed July 1, 2001-December 31, 2008, suicide risk was independently associated with male sex and mental disorders but not with military-specific variables. These findings may inform approaches to mitigating suicide risk in this population.

  • Publication Status: Published
  • Sponsoring Organization: DoD agency, office, or organization other than the Army, Navy, Air Force, or Defense Health Agency
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source: Agency, office or organization under authority of the Sec Def (not affiliated to Army, Navy, or Air Force)
  • Release Date/Publication: August 01, 2013
  • Citation: LeardMann CA, Powell TM, Smith TC, Bell MR, Smith B, Boyko EJ, Hooper TI, Gackstetter GD, Ghamsary M, Hoge CW. Risk factors associated with suicide in current and former US military personnel. JAMA. 2013 Aug 7;310(5):496-506
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Last Updated: September 21, 2022
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