Injuries and Factors Associated with Injuries Among U.S. Army Band Musicians.

The Department of Defense is the largest employer of full-time musicians. In the U.S. military, many musicians experience unique occupational exposures such as extended periods of standing, sitting, and marching for rehearsals and performances, static and non-neutral postures, and a variety of repetitive motions while playing instruments. These exposures are in addition to physical training and fitness standards required of U.S. Army soldiers. METHODS: An electronic survey was administered to active-duty U.S. Army Band musicians. The survey collected demographics, personal characteristics, Army Physical Fitness Test performance, occupational demands, health behaviors, and injuries from October 2017 to December 2018. Survey responses were combined with medical and physical fitness performance records. Descriptive statistics were reported and factors associated with injuries were investigated. RESULTS: There were 465 Army Band members in this population, with approximately half (49%) completing the survey. Most survey respondents (81%) reported an injury in the past year, which they predominantly attributed to overuse (54%). Leading reported activities resulting in injury included running for physical training (21%), repetitive movements while playing an instrument (11%), and standing while playing (11%). A majority of survey respondents (60%) also had a medical encounter for an injury. Factors significantly associated with injury among men were lower aerobic fitness and higher body fat percentage; additional unadjusted factors associated with injury among all Army Band soldiers included female sex, older age, and longer periods of marching and standing while playing. CONCLUSIONS: Injury prevention initiatives for Army Band musicians should focus on the reduction of overuse and repetitive motion injuries. Suggested prevention strategies include balanced physical training, ergonomic adjustments, rehearsal breaks, and leadership support for injury prevention efforts.

The cost of lower extremity fractures among active duty U.S. Army soldiers, 2017.

The estimated cost to the Army for lower extremity fractures in 2017 was approximately $116 million. Direct medical expenses totaled $24 million, and indirect medical costs totaled $92 million ($900 thousand lost duty; $91 million limited duty). Foot and toe fractures, along with lower leg and ankle fractures accounted for the majority of soldiers' initial visits for care (n=4,482; 91.6%), and more than $103 million (89.0%) of overall costs ($116 million). Costs varied by location of care. In outpatient settings, initial visits for foot and toe injuries accounted for the highest costs: $49 million overall. Direct medical costs totaled $1.2 million, and indirect medical costs (limited duty) were $48 million. Conversely, in inpatient settings, lower leg and ankle fractures accounted for slightly more than half of all costs (overall $9 million; $4.8 million in direct medical costs and $4.5 million in indirect medical costs). The finding that the majority of costs related to lower extremity fractures were due to estimated days of lost or limited duty and associated loss of productivity justifies the inclusion of indirect cost estimates as a part of overall injury cost calculations.

The Impacts of ICD-10-CM on U.S. Army Injury Surveillance.

INTRODUCTION: Injuries are the leading cause of medical encounters and lost work days in the U.S. Army, affecting more than half of active-duty soldiers annually. Historically, Army injury surveillance has captured both acute traumatic and cumulative microtraumatic overuse injuries. This article describes how the transition from the ICD-9-CM to ICD-10-CM impacted U.S. military injury surveillance by comparing injury rates and distributions under both systems. METHODS: Mapping ICD-9-CM codes to the expanded ICD-10-CM codes is not a straightforward endeavor; therefore, the Army Public Health Center incorporated ICD-10-CM codes into a comprehensive, systematic approach to taxonomically categorize injuries. This taxonomic methodology was applied to Army injuries under ICD-10-CM (2016-2019) and compared with the ICD-9-CM Army injury surveillance definitions (2012-2015). RESULTS: Soldier injury rates appeared to increase when surveillance with ICD-10-CM began. Soldiers experienced 1,276 incident injury medical encounters per 1,000 person-years in 2015 (ICD-9-CM), compared with 1,804 injuries per 1,000 in 2016 (ICD-10-CM), a 41% increase. Importantly, the distribution of injuries also shifted, such that the average cumulative microtraumatic injury rate increased by 42% during 2016-2019 (ICD-10-CM) compared with the 2012-2015 average (ICD-9-CM), whereas acute traumatic injuries only increased by 17%. CONCLUSIONS: The enhanced descriptions provided by ICD-10-CM codes and the applied taxonomic categorizations have improved precision in Army injury surveillance. Data unequivocally show that most injuries in this physically active population are cumulative microtraumatic injuries. The taxonomic methodology can be extended to injury surveillance in other populations and may allow a more efficient transition to ICD-11-CM.

Factors associated with medical problems among young non-deployed U.S. military working dogs.

The goals of this project were to quantify medical problems among a population of Military Working Dogs (MWDs) and analyze factors associated with common medical conditions. Medical conditions recorded in veterinary Master Problem List (MPL) entries for 774 young, non-deployed, active MWDs were categorized and combined with demographic information to analyze risk factors. Most dogs were male (74%), German Shepherd (39%) or Belgian Malinois (31%) breeds, certified in Explosive Detection (60%), and had a dark coat color (83%). Ages ranged from one to six years, with an average of 2.6 years (± 0.5 years). Eighty-three percent of dogs had a non-surgical medical problem in their record. The most common non-surgical medical problems were dermatologic (25% of MPL entries), alimentary (21%), dental (15%), soft-tissue injury (10%), and musculoskeletal conditions (4%). Factors associated with each medical condition were breed (Odds Ratios 1.96-8.24), sex and spay/neuter status (ORs 1.78-5.77), occupational duty certification (ORs 2.65-3.62), military command location (ORs 2.32-7.44), and military branch (OR 5.16). As MWDs are a valuable asset for the Department of Defense, training and work conditions for the identified at-risk groups of MWDs should be further assessed to maximize their operational capabilities and assess the potential to serve as sentinel indicators for human diseases. Improved understanding of the most common medical problems affecting MWDs, and the identification of factors associated with these conditions, can help drive changes in their preventive care.

Risk factors for injury among military working dogs deployed to Iraq.

There is limited literature concerning the types of injuries that military working dogs (MWDs) face while in a deployed theater of operations and associated risk factors. To summarize injuries and identify injury risk factors in MWDs during their first deployments to Iraq, demographic and medical data were collected for 794 MWDs from the U.S. Army, Air Force, Navy, and Marine Corps that deployed to Iraq between March 20, 2003 and December 31, 2007. Sixty-two percent (n = 490) had a medical encounter during deployment. Injuries were categorized as traumatic or musculoskeletal. MWD demographics, characteristics, and injury types were summarized. Injury risk factors were assessed using multivariable logistic regression. A majority of the population were German Shepherds (56 %), intact males (49 %), and dogs certified in both patrol and explosives detection (73 %). During their first deployment to Iraq, 20 % (n = 156) experienced an injury. Risk factors included breed, age, and occupational certification. Belgian Malinois and Labrador Retriever dogs had greater odds of injury compared to German Shepherds (p = 0.04 and p = 0.02) and the oldest MWDs had about a 50 % higher risk of injury compared to the youngest (p = 0.01), especially for musculoskeletal injuries. MWDs with Specialized Search certification were at increased injury risk (p = 0.02). Training, equipment, and supplies for veterinary service personnel, MWD handlers, and MWDs should be tailored with consideration of the injury risks of the MWD population. Further study is needed to investigate chronic injuries in military working dogs to better understand causation and prevention.

Using causal energy categories to report the distribution of injuries in an active population: An approach used by the U.S. Army.

OBJECTIVES: To describe the etiologic distribution of all injuries among U.S. Army Active Duty soldiers by causal energy categories. DESIGN: Retrospective cohort, descriptive analysis. METHODS: Injury was defined as the interruption of tissue function caused by an external energy transfer (mechanical, thermal, radiant, nuclear, chemical, or electrical energy). A comprehensive injury matrix standardized categories by causal energies, body locations, and injury types. Categories differentiated acute (ACT) from cumulative micro-traumatic (CMT) overuse injuries, and musculoskeletal injuries (MSKI) from those affecting other or multiple body systems (non-MSKI). International Classification of Diseases (ICD) diagnoses codes were organized into established categories. The matrix was applied to electronic health records for U.S. Army soldiers in 2017. RESULTS: Mechanical energy transfers caused most injuries (97%, n = 809,914): 76% were CMT overuse and the remaining were ACT (<21%). The majority (83%) were MSKI (71% CMT, 12% ACT). While almost one-half (47%) were to lower extremities (38% CMT, 9% ACT) the most frequently injured anatomical sites were the knee and lower back (16% each, primarily CMT). CONCLUSIONS: For the first time all soldiers' injuries have been presented in the same context for consistent comparisons. Findings confirm the vast majority of injuries in this physically-active population are MSKI, and most are CMT MSKI. A very small portion are non-MSKI or injuries caused by non-mechanical energy (e.g., heat- or cold-weather). Most Army injuries are to the lower extremities as a grouped body region, but additional matrix specificity indicates the most injured anatomical locations are the knee, lower back, and shoulder.

Accuracy of self-reported injuries compared to medical record data.

BACKGROUND: Self-reported injury data are frequently used in epidemiologic investigations. These data provide useful information about the activities and mechanisms of injuries because injury cause-coding is often not required for outpatient medical visits. OBJECTIVES: The purpose of this evaluation is to determine the accuracy of self-reported military injuries when compared to injuries in outpatient medical records. METHOD: Injuries reported by survey were compared to diagnoses for injuries (International Classification of Diseases (ICD-9-CM 800-999)) and injury-related musculoskeletal disorders (selected ICD-9-CM 710-739) obtained from medical records. Self-reported injury responses from military personnel were matched to diagnoses by date and body part. A new methodology for including secondary matching body parts was proposed and implemented. RESULTS: Infantry Soldiers (n = 5490) completed surveys that requested details about their most recent injury. About one-quarter (24%, n = 1336) reported injuries on the survey and had an injury diagnosis in their medical record in a six month period. Seventy-five percent of the self-reported injuries (n = 996 of 1336) were confirmed by medical records with a date match within 3 months and an identical or nearby body part. Common self-reported injuries were ankle sprains (10%), knee sprains (9%), lower back strains (4%), shoulder strains (3%), and lower back pain (3%). CONCLUSIONS: A high percentage of self-reported injuries were accurate when compared with medical records, substantiating the use of survey data for the evaluation of injury outcomes. This is the first effort to validate self-reported injuries and musculoskeletal disorders with medical records in a large military population.

Factors Associated With Injury Among Employees at a U.S. Army Hospital.

The purpose of this study was to investigate injury incidence and factors associated with injury among employees at a large U.S. Army hospital to inform injury prevention planning and health promotion education efforts. Demographics, health behaviors, and injury history were collected by survey from hospital employees between October and December 2014. Descriptive statistics were reported and factors associated with injury were determined using multiple logistic regression. Respondents (380; 56% females, 44% males; 54% active duty military, 45% civilians) reported a prevalence of unhealthy behaviors (e.g., not enough exercise [58%] and poor sleeping habits [49%]). Nearly half of respondents (47%) reported at least one occupational injury in the past 12 months. Leading mechanisms of injuries were repetitive overuse (36%), falls (15%), and single twisting movement/overexertion (14%). Leading activities at the time of injury were physical training (24%), walking/hiking (15%), and lifting or moving objects (11%). Factors associated with injury included active duty military status, less education, tobacco use, overuse of alcohol or drugs, and stress. Health education efforts and materials intended for hospital staff should incorporate identified modifiable injury risk factors (e.g., alcohol and drug use, stress, tobacco use, poor sleep). Injury prevention initiatives should focus on physical training, walking/hiking, and lifting. Establishment of surveillance and routine review of employee injury, illness, and health behavior data are recommended to monitor program effects and collect data necessary to inform future prevention priorities and planning.

Risk factors for injury associated with low, moderate, and high mileage road marching in a U.S. Army infantry brigade.

OBJECTIVES: Road marching is an important physical training activity that prepares soldiers for a common occupational task. Continued exploration of risk factors for road marching-related injuries is needed. This analysis has assessed the association between modifiable characteristics of physical training and injury risk. METHODS: Injuries in the previous 6 months were captured by survey from 831 U.S. Army infantry soldiers. Road marching-related injuries were reported as those attributed to road marching on foot for specified distances while carrying equipment. Frequencies, means, and relative risk ratios (RR) for road marching-related injury with 95% confidence intervals (CI) were calculated. Adjusted odds ratios (OR) and 95% CI were calculated for leading risk factors using multivariable logistic regression. DESIGN: Retrospective cohort study. RESULTS: Half (50%) of reported injuries were attributed to road marching or running. When miles of exposure were considered, injury risk during road marching was higher than during running (RRroad marching/running=1.8, 95% CI: 1.38-2.37). A higher product of road marching distance and weight worn (pound-miles per month) resulted in greater injury risk (RR≥1473 pound-miles/<1472=1.92, 95% CI: 1.17-2.41). Road marching-related injuries were associated with carrying a load >25% of one's body weight (OR>25%/1-20%=2.09, 95% CI: 1.08-4.05), having high occupational lifting demands (OR50-100+lbs/25-50lbs=3.43, 95% CI: 1.50-7.85), road marching ≥5 times per month (OR≥5 times/4 times=2.11, 95% CI: 1.14-3.91), and running <4 miles per week during personal physical training (OR0/≥10 miles/week=3.56, 95% CI: 1.49-8.54, OR1-4/≥10 miles/week=4.14, 95% CI: 1.85-9.25). CONCLUSIONS: Ideally, attempts should be made to decrease the percentage of body weight carried to reduce road marching-related injuries. Since this is not always operationally feasible, reducing the cumulative overloading from both physical training and occupational tasks may help prevent injury.