TY - JOUR
T1 - Noncardiac chest pain during war
AU - Cohen, Steven P.
AU - Kapoor, Shruti G.
AU - Anderson-Barnes, Victoria C.
AU - McHenry, Marie
AU - Nguyen, Conner
AU - Rao, Dinesh
AU - Plunkett, Anthony
N1 - Funding Information:
Funded in part by a Congressional Grant from the John P. Murtha Neuroscience and Pain Institute, Johnstown, PA; and the Army Regional Anesthesia and Pain Medicine Initiative, Washington, DC. These organizations played no role in the study design, data collection, or drafting of the manuscript. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense. Disclosures/Conflicts of Interest: None.
PY - 2011/1
Y1 - 2011/1
N2 - Objectives: Noncardiac chest pain (NCCP) has emerged as one of the biggest challenges facing military healthcare providers. The objectives of this study are to determine disease burden and diagnostic breakdown of NCCP, and to identify factors associated with return-to-duty (RTD). Methods:: Data were prospectively collected from the Deployed Warrior Medical Management Center in Germany on 1935 service and nonservice members medically evacuated out of Operations Iraqi and Enduring Freedom for a primary diagnosis of NCCP between 2004 and 2007. Electronic medical records were reviewed to examine the effect myriad factors had on RTD. RESULTS: One thousand nine hundred thirty-five personnel were medically evacuated with a diagnosis of NCCP, of whom 92% were men, 70% were in the Army, and 79% sustained their injury in Iraq. Fifty-eight percent returned to duty. The most common causes were musculoskeletal (23.4%), unknown (23%), cardiac (21%), pulmonary (13.9%), and gastrointestinal (11.9%). Factors associated with a positive outcome were being a commissioned officer [adjusted odds ratio (OR) 1.87, P=0.009]; serving in the navy (OR 2.25, P=0.051); having a noncardiac etiology, including gastrointestinal (adjusted OR 5.65, P<0.001), musculoskeletal (OR 4.19, P<0.001), pulmonary (OR 1.80, P=0.018), psychiatric (OR 2.11, P=0.040), or neuropathic (OR 5.05, P=0.040) causes; smoking history (OR 1.54, P=0.005); and receiving no treatment for chest pain (OR 2.17, P=0.006). Covariates associated with a decreased likelihood of RTD were service in Iraq (OR 0.68, P=0.029) and treatment with opioids (OR 0.59, P=0.006) or adjuvants (OR 0.61, P=0.026). Conclusions:: NCCP represents a significant cause of soldier attrition during combat operations, but is associated with the highest RTD rate among any diagnostic category. Among various causes, gastrointestinal is associated with the highest RTD rate.
AB - Objectives: Noncardiac chest pain (NCCP) has emerged as one of the biggest challenges facing military healthcare providers. The objectives of this study are to determine disease burden and diagnostic breakdown of NCCP, and to identify factors associated with return-to-duty (RTD). Methods:: Data were prospectively collected from the Deployed Warrior Medical Management Center in Germany on 1935 service and nonservice members medically evacuated out of Operations Iraqi and Enduring Freedom for a primary diagnosis of NCCP between 2004 and 2007. Electronic medical records were reviewed to examine the effect myriad factors had on RTD. RESULTS: One thousand nine hundred thirty-five personnel were medically evacuated with a diagnosis of NCCP, of whom 92% were men, 70% were in the Army, and 79% sustained their injury in Iraq. Fifty-eight percent returned to duty. The most common causes were musculoskeletal (23.4%), unknown (23%), cardiac (21%), pulmonary (13.9%), and gastrointestinal (11.9%). Factors associated with a positive outcome were being a commissioned officer [adjusted odds ratio (OR) 1.87, P=0.009]; serving in the navy (OR 2.25, P=0.051); having a noncardiac etiology, including gastrointestinal (adjusted OR 5.65, P<0.001), musculoskeletal (OR 4.19, P<0.001), pulmonary (OR 1.80, P=0.018), psychiatric (OR 2.11, P=0.040), or neuropathic (OR 5.05, P=0.040) causes; smoking history (OR 1.54, P=0.005); and receiving no treatment for chest pain (OR 2.17, P=0.006). Covariates associated with a decreased likelihood of RTD were service in Iraq (OR 0.68, P=0.029) and treatment with opioids (OR 0.59, P=0.006) or adjuvants (OR 0.61, P=0.026). Conclusions:: NCCP represents a significant cause of soldier attrition during combat operations, but is associated with the highest RTD rate among any diagnostic category. Among various causes, gastrointestinal is associated with the highest RTD rate.
KW - combat
KW - etiology
KW - nonbattle injury
KW - noncardiac chest pain
KW - war
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U2 - 10.1097/AJP.0b013e3181f06b06
DO - 10.1097/AJP.0b013e3181f06b06
M3 - Article
C2 - 20842022
AN - SCOPUS:78650864382
SN - 0749-8047
VL - 27
SP - 19
EP - 26
JO - Clinical Journal of Pain
JF - Clinical Journal of Pain
IS - 1
ER -