Ongoing analysis of surveillance data from the Defense Medical Surveillance System (DMSS), a central repository of all inpatient and outpatient medical encounters for US military personnel, is a key source of information on military injuries.2 The data presented here were obtained from the Armed Forces Health Surveillance Center, and prepared by the Army Institute of Public Health, Injury Prevention Program. Data on fatalities, hospitalizations, and outpatient visits were obtained and analyzed for all nondeployed US Army soldiers in the Active Component, hereafter referred to as "active duty." The analysis is limited to nondeployed Army since recent standardized medical encounter data are most reliably captured in the nondeployed (garrison) environment.
Fatality data contained in the DMSS originate from two data sources: Washington Headquarters Service and the Armed Forces Institute of Pathology. Hospitalization (inpatient) and outpatient visit data are obtained from DMSS, which draws data from the Military Health System (MHS) Executive Information and Decision Support data systems. Data include treatment received within the MHS, as well as treatment outside the MHS that was paid for by the US military. All data on medical conditions other than injuries are reported according to the 17 major diagnosis code groups as outlined in the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM).3 Injuries resulting in hospitalization and outpatient treatment were identified by ICD-9-CM diagnosis codes from the 800–999 code series for acute (traumatic) injuries and 710–739 code series for injury-related (chronic) musculoskeletal conditions, in concordance with recommendations for monitoring of military injuries.4
Consistent with prior reporting,5,6 injuries and injury-related musculoskeletal conditions are reported in combination in the “injury and musculoskeletal” category. Injury-related musculoskeletal conditions include conditions such as Achilles tendinitis (code 726.71), meniscal tears of the knee (codes 717.0–717.5), non-traumatic rupture of the quadriceps (code 727.65), and tibial stress fracture (code 733.93). Other non-injury conditions in the 710–739 ICD-9 codes series, such as rheumatoid arthritis and arthropathies associated with infection, are captured in the “musculoskeletal, non-injury” category. With the exception of the Relative Burden analysis, a 60-day ”unique hospitalization/outpatient rule” was used in this analysis in order to reduce the effect of follow-up injury visits and potential overestimation of frequencies and rates. The rule states that multiple visits for the same three-digit ICD-9-CM diagnosis within 60 days of the initial visit will be counted only once.
Causes of injury hospitalizations are coded at the military treatment facility using the coding scheme outlined in the North Atlantic Treaty Organization (NATO) Standardization Agreement (STANAG) No. 2050, ed. 5.7 The coding system is employed for coding all injury hospitalizations, but is required for the first (incident) visit for acute injuries only.8 The STANAG codes are four-digit codes describing the intent/situation of the injury incident, injury cause, and location at which the injury occurred. This report includes injury hospitalizations coded as accidental (a STANAG trauma code, or first digit, of 5–9), which are used in this analysis, and hereafter referred to as unintentional injuries. Outpatient injury cause coding is not yet required in the military health system, although ICD-9 external cause of injury cause codes may be recorded. In this report, data for incident outpatient injury visits with an ICD-9 external cause of injury code are reported.
- 1. Mortality Surveillance in the US Army, 2005–2011. Army Institute of Public Health; July 2014.
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- 3. National Center for Health Statistics. The International Classification of Diseases, ed. 9. Revision, Clinical Modification (ICD-9-CM). Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Centers for Medicaid and Medicare Services.
- 4. DoD Military Injury Metrics Working Group White Paper: Washington, DC: Office of the Assistant Secretary of Defense for Health Affairs, Clinical and Program Policy. 2002.
- 5. Jones BH, M Canham-Chervak, S Canada, T Mitchener, S Moore. Medical surveillance of injuries in the US military: Descriptive epidemiology and recommendations for improvement. Amer J Prev Med 2010;38(1S):S42-S60.
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- 7. Military Agency for Standardization, North Atlantic Treaty Organization. 2 March 1989. Standardized Classification of Diseases, Injuries, and Causes of Death. 5th ed: STANAG 2050.
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