A process to identify military injury prevention priorities based on injury type and limited duty days

Am J Prev Med. 2010 Jan;38(1 Suppl):S19-33. doi: 10.1016/j.amepre.2009.10.004.


Background: Injuries, one of the leading public health problems in an otherwise healthy military population, affect operational readiness, increase healthcare costs, and result in disabilities and fatalities. This paper describes a systematic, data-driven, injury prevention-decision making process to rank potential injury prevention targets.

Methods: Medical surveillance and safety report data on injuries for 2004 were reviewed. Nonfatal injury diagnoses (ICD-9-CM codes) obtained from the Defense Medical Surveillance System were ranked according to incident visit frequency and estimated limited duty days. Data on the top five injury types resulting in the greatest estimated limited duty days were matched with hospitalization and Service Safety Centers' accident investigation data to identify leading causes. Experts scored and ranked the causes using predetermined criteria that considered the importance of the problem, preventability, feasibility, timeliness of intervention establishment/results, and ability to evaluate. Department of Defense (DoD) and Service-specific injury prevention priorities were identified.

Results: Unintentional injuries lead all other medical conditions for number of medical encounters, individuals affected, and hospital bed days. The top ten injuries resulted in an estimated 25 million days of limited duty. Injury-related musculoskeletal conditions were a leading contributor to days of limited duty. Sports and physical training were the leading cause, followed by falls.

Conclusions: A systematic approach to injury prevention-decision making supports the DoD's goal of ensuring a healthy, fit force. The methodology described here advances this capability. Immediate follow-up efforts should employ both medical and safety data sets to identify and monitor injury prevention priorities.

MeSH terms

  • Accident Prevention / methods*
  • Accidents / statistics & numerical data
  • Decision Support Techniques
  • Health Priorities / standards*
  • Humans
  • Military Medicine / methods*
  • Military Personnel / statistics & numerical data*
  • Population Surveillance / methods
  • Program Development / methods
  • Sick Leave
  • Trauma Severity Indices
  • United States / epidemiology
  • Wounds and Injuries / epidemiology
  • Wounds and Injuries / prevention & control*