• Military medicine · Feb 2020

    Severe Upper Limb Injuries in U.S. Military Personnel: Incidence, Risk Factor and Outcomes.

    • Colleen A Daniels, Cara H Olsen, Ann I Scher, Patricia L McKay, and David W Niebuhr.
    • Department of Preventive Medicine and Biostatistics, F.E. Hebert School of Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814.
    • Mil Med. 2020 Feb 12; 185 (1-2): e146-e153.

    BackgroundSevere upper limb injuries (SULI) may pose a significant public health challenge for the military; however, SULI has not been previously defined or studied in the US military. Objective: Determine SULI incidence, risk factors, and outcomes.Materials And MethodsActive Component (AC) U.S. military personnel who served during January 1, 2003 to December 31, 2012 who met the case definition for SULI (N = 213,745) and a random sample from the same population without SULI were included. Data from the Defense Medical Surveillance System and Defense Medical Epidemiology Database was used to calculate incidence. Multiple logistic regression and Cox proportional hazards models were used to analyze SULI risk factors and attrition.ResultsSULI incidence was 15/1,000 person-years. Higher SULI risk was observed in men (OR 1.25; 95% CI 1.22-1.27), age 25-29 (OR 1.07; 95% CI 1.05-1.09) compared to age 20-24, E5-E9 (OR 1.14; 95% CI 1.12-1.17) compared to E1-E4, serving in Coast guard (OR 1.62; 95% CI 1.56-1.68) and Air Force (OR 1.17; 95% CI 1.14-1.19) relative to Army and with a deployment history (OR 2.16, 95% CI 2.12-2.19) while SULI risk was lower for blacks (OR 0.91; 95% CI 0.90-0.93) and those in the "other race" category (HR 0.81; 95% CI 0.80-0.84) compared to whites. SULI was associated with 23% increased risk of attrition (HR 1.23; 95% CI 1.22-1.24).ConclusionThe study findings provide preliminary evidence on the incidence, natural history and distribution of SULI in this population. The findings indicate SULI may impact readiness and result in premature military separation.© Association of Military Surgeons of the United States 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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