The Influence of Musculoskeletal Conditions, Behavioral Health Diagnoses, and Demographic Factors on Injury-Related Outcome in a High-Demand Population

Abstract

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Is There Variation in Procedural Utilization for Lumbar Spine Disorders Between a Fee-for-Service and Salaried Healthcare System?

“…TRICARE is not involved in the care of servicemembers in combat theaters [16] nor does the plan provide services through the Veterans Administration [18,22]. TRICARE beneficiaries may receive care in the purchased care setting for a variety of reasons, including personal preference and location of their residence.…”

“…TRICARE data have previously been utilized in other initiatives evaluating the delivery of surgical services in a number of different contexts [3,18,22]. Moreover, the broad demographic insured through TRICARE, which covers individuals of extremely varied sociodemographic, educational, professional, and vocational backgrounds, has been considered representative of the American population aged 18 to 64 years in prior studies [3,16,18,22].…”

“…Sponsor military rank was classified as officer, enlisted junior (lowest four ranks in any branch of service), senior enlisted (noncommissioned officers), and other (warrant officers and cadets). In line with prior research using TRICARE data, sponsor military rank was considered a proxy for socioeconomic status in this analysis with individuals in the enlisted junior category maintained to be representative of those in lower socioeconomic circumstances [6,16,18,22]. The type of surgical intervention was determined using ICD-9 procedure codes and defined as discectomy, decompression, posterolateral fusion, and interbody fusion using a previously published algorithm [17].…”

Musculoskeletal Injuries in Iraq and Afghanistan

“…10,14 The first widespread use of individual body armor and Kevlar (DuPont) helmets occurred during the wars in Iraq and Afghanistan, which reduced the overall percentage of thoracic injuries and diminished the impact of otherwise life-threatening wounds. 1,5,7,12 Mechanisms of Injury During the major military conflicts of the 20th century, the incidence of gunshot-related combat injuries declined, whereas the incidence of trauma resulting from blast mechanisms, such as artillery shell, landmine, or grenade, increased 1,2,5 (Table 1) 5 Belmont et al 11 evaluated the nature of injury mechanisms more directly in a prospective cohort of soldiers who were deployed to Iraq over a 15-month period as part of the Iraq war troop surge. 1,5,7,12 Mechanisms of Injury During the major military conflicts of the 20th century, the incidence of gunshot-related combat injuries declined, whereas the incidence of trauma resulting from blast mechanisms, such as artillery shell, landmine, or grenade, increased 1,2,5 (Table 1) 5 Belmont et al 11 evaluated the nature of injury mechanisms more directly in a prospective cohort of soldiers who were deployed to Iraq over a 15-month period as part of the Iraq war troop surge.…”

“…12 The cohort consisted of a single US Army BCT deployed to Iraq for a 15-month period during the Iraq war troop surge. This study was designed in a multilevel fashion to capture all orthopaedic injuries and other war trauma sustained by soldiers (level I); nested in units of maneuver as Army battalions or squadrons (level II); occurring within a unit of deployment, such as an Army brigade combat team (BCT, level III); and treated after return to the United States (level IV).…”