Abstract
BackgroundBlast injury emerged as a primary source of morbidity among US military personnel during the recent conflicts in Iraq and Afghanistan, and led to an array of adverse health outcomes. Multimorbidity, or the presence of two or more medical conditions in an individual, can complicate treatment strategies. To date, there is minimal research on the impact of multimorbidity on long-term patient-reported outcomes. We aimed to define multimorbidity patterns in a population of blast-injured military personnel, and to examine these patterns in relation to long-term quality of life (QOL).MethodsA total of 1972 US military personnel who sustained a blast-related injury during military operations in Iraq and Afghanistan were identified from clinical records. Electronic health databases were used to identify medical diagnoses within the first year postinjury, and QOL was measured with a web-based assessment. Hierarchical cluster analysis methods using Ward’s minimum variance were employed to identify clusters with related medical diagnosis categories. Duncan’s multiple range test was used to group clusters into domains by QOL.ResultsFive distinct clusters were identified and grouped into three QOL domains. The lowest QOL domain contained one cluster with a clinical triad reflecting musculoskeletal pain, concussion, and mental health morbidity. The middle QOL domain had two clusters, one with concussion/anxiety predominating and the other with polytrauma. The highest QOL domain had two clusters with little multimorbidity aside from musculoskeletal pain.ConclusionsThe present study described blast-related injury profiles with varying QOL levels that may indicate the need for integrated health services. Implications exist for current multidisciplinary care of wounded active duty and veteran service members, and future research should determine whether multimorbidity denotes distinct post-blast injury syndromes.
Highlights
Blast injury emerged as a primary source of morbidity among United States (US) military personnel during the recent conflicts in Iraq and Afghanistan, and led to an array of adverse health outcomes
The current study presents baseline patient-reported data for 1972 participants who were identified as having a blast-related injury between February 2003 and August 2014 after detailed review of their Expeditionary Medical Encounter Database (EMED) clinical record, and had baseline Wounded Warrior Recovery Project (WWRP) assessments conducted between November 2012 and April 2017
Because this study examined multimorbidity, participants required a minimum of two ICD-9-CM codes in at least two of these Classifications Software (CCS) categories to be included in the study
Summary
Blast injury emerged as a primary source of morbidity among US military personnel during the recent conflicts in Iraq and Afghanistan, and led to an array of adverse health outcomes. In the Iraq and Afghanistan wars, concussions, serious extremity injuries, and amputations evidenced an unprecedented rise that paralleled the heightened use of blast weaponry [5,6,7,8]. Sensory injuries, such as hearing and vision deficits, have been linked to blasts as well [9,10,11,12]. The effects of blast move well beyond the physical, as the nature and circumstances of blast injury can often lead to psychological problems such as posttraumatic stress disorder (PTSD) and depression [13,14,15]
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