Citation

Schmied EA, Boltz J, Levine JA, Koenig H, Forbang N, Shero J, Dearth C, Thomsen CJ. PM R 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, American Academy of Physical Medicine and Rehabilitation, Publisher Elsevier Publishing)

DOI

10.1002/pmrj.12954

PMID

36730162

Abstract

INTRODUCTION: To determine whether rates of all-cause and cause-specific mortality are elevated for active duty US service members who sustained traumatic limb injuries in service, compared to the broader population of deploying service members. To assess differences in mortality rates between service members with traumatic limb injuries that did versus did not result in amputation.

DESIGN: Retrospective cohort study; archival Department of Defense deployment, personnel, medical, and death records were combined and analyzed. Standardized mortality ratios (SMR) adjusted for age, sex, and race/ethnicity, along with associated 95% confidence intervals (CI), were calculated to directly compare all-cause and cause-specific mortality rates in each of the two injury groups to rates in the total study population. SETTING: Not applicable. PARTICIPANTS: Service members who deployed in support of the Global War on Terror between 2001 and 2016 were eligible for inclusion; the final sample included 1,875,206 individual surveilled through 2019. INTERVENTION: Not applicable. MAIN OUTCOME MEASURED: All-cause and cause-specific mortality rates.

RESULTS: Overall, the number of deaths was over three times higher than expected among service members with amputations (SMR=3.01; CI: 2.36, 3.65), and nearly two times higher among those with serious limb injuries not resulting in amputation (SMR=1.72; CI: 1.54, 1.90) when compared to the larger study population. Rates for both internal and external causes of death were significantly elevated among those with limb injuries.

CONCLUSIONS: Long-term mortality rates are elevated among service members with traumatic limb injuries, though mortality patterns may differ based on whether the injury results in amputation. While further research into causal mechanisms is needed, these results may inform the development of interventions to improve long-term health outcomes among injured military personnel. This article is protected by copyright. All rights reserved.

Language: en