Hospitalization due to injuries in the military - Evaluation of current data and recommendations on their use for injury prevention

Introduction: Injuries inflict the largest health impact on military popula tions in terms of hospitalization. Hospitalized injuries result in the larg est direct costs of medical care and the most lost workdays, include the la rgest proportion of disabling injuries, and have the largest impact on troo p readiness. Efforts are now beginning to focus on how injury surveillance data can be used to reduce the burden of injuries, This article examines th e value of administrative hospital discharge databases in the military for routine injury surveillance, as well as investigation of specific injury pr oblems, including musculoskeletal conditions that are frequently sequelae o f old injuries. Methods: Data on hospitalizations for injuries and musculoskeletal conditio ns were obtained from separate administrative agencies for the Army, Navy, and Air Force. Since 1989, a Standard Inpatient Data Record (SIDR) has been used to ensure uniformity in data collection across the services utilizing standard ICD-9 codes. Cause of injury was coded using special military cau se codes (STANAG codes) developed by NATO. Data were analyzed on both natur e and cause of injury. Denominator data on troop strength were obtained fro m the Defense Manpower Data Center (DMDC). Results: Hospital records data indicate that injuries and musculoskeletal c onditions have a bigger impact on the health of service members and militar y/combat readiness than any other ICD-9 Principal Diagnostic Group (higher incidence and higher noneffective rate or days not available for duty). Hos pitalization rates for injury appeared to decline for all services from 198 0 to 1992. In 1992, service-specific injury hospitalization rates per 1000 person-years were 15.6 for the Army, 8.3 for the Navy (enlisted only), and 7.7 for the Air Force, while die corresponding hospitalization rate for mus culoskeletal conditions was higher in all three services: 28.1, 9.7, and 12 .0, respectively. Conclusions: Military hospital discharge databases are an important source of information on severe injuries and are more comprehensive than civilian databases. They include detailed injury information that can be useful for injury prevention acid surveillance purposes. Specifically, it can be used to identify high-risk groups or hazards for targeting prevention resources. These may vary widely by service, rank, and job tasks. Hospital discharge data can also be used to evaluate the effectiveness of interventions for re ducing injury rates. Recommendations were submitted to further improve data collection and the use of hospital data for research and injury prevention . (C) 2000 American Journal of Preventive Medicine.