背景:疾病和非战斗伤害(DNBI)历来是战争中服役人员的主要伤亡类型,也是军事人员面临的主要健康问题,造成人力重大损失。研究表明,与战斗相关损伤相比,DNBI的疾病负担显着增加。了解DNBI的原因和趋势可能有助于指导制定预防措施的努力,并有助于提高医疗准备和弹性。然而,尽管军人的疾病负担很大,与战斗伤害相比,DNBI的研究较少。在这次审查中,我们旨在评估最近发表的有关DNBI的文献,并描述这些最近发表的研究的特点.
方法:本系统评价报告于前瞻性系统评价注册数据库。已发表的文章的系统搜索是在2022年7月21日进行的,在护理和相关健康的累积指数中,科克伦图书馆,国防技术信息中心,Embase,和PubMed。以系统评价和荟萃分析的首选报告项目为指导,研究者独立筛选了Covidence网站(covidence.org)上的参考列表.如果文章符合以下任何标准,则将其排除在外:(1)非英文发表;(2)在2010年之前发表;(3)2001年之前使用的数据;(4)病例报告,评论,和编辑信;(5)系统评价或叙述性评价;(6)使用动物模型;(7)机械或生物力学研究;(8)结果是战斗伤害或未指定;(9)样本是退伍军人,国防部平民,承包商,当地国民,外国军队,(10)样本为美国军事学院;(11)样本未部署;(12)生物恐怖主义研究;(13)定性研究。对2名独立研究者的全文审查达成了96%的总体一致(173篇文章中的166篇;κ=0.89)。第三审稿人解决了分歧。从每篇文章中提取研究特征和结果。使用纽卡斯尔-渥太华量表评估偏倚风险。疾病发病率汇总估计的荟萃分析(D),非战斗伤害(NBI)并使用随机效应模型创建组合DNBI。
结果:在3,401篇文章中,173人被纳入全面审查,29人(16.8%)符合所有纳入标准。在29项研究中,21(72.4%)是回顾性设计,5(17.2%)是前瞻性设计,3项(10.3%)为调查。在所有研究中,报告的病例总数中位数为1,626例(四分位距:619.5-10,203例).8项研究的荟萃分析结果报告了D的发病率(每1000人年)(n=3),NBI(n=7),DNBI(n=5)显示D的合并发病率为22.18/1000人年,NBI每千人年19.86,合并DNBI的每1000人年50.97。在3项D发病率研究中,NBI,和战斗伤害,D的发病率为每千人年20.32,NBI每千人年6.88,战伤为每千人年6.83。
结论:在过去20年中,DNBI仍然是美国军方冲突发病的主要原因。需要更多具有更强设计和一致测量的研究,以提高医疗准备水平并保持部队杀伤力。
方法:系统评价和荟萃分析,三级。
BACKGROUND: Disease and non-battle injury (DNBI) has historically been the leading casualty type among service members in warfare and a leading health problem confronting military personnel, resulting in significant loss of manpower. Studies show a significant increase in disease burden for DNBI when compared to combat-related injuries. Understanding the causes of and trends in DNBI may help guide efforts to develop preventive measures and help increase medical readiness and resiliency. However, despite its significant disease burden within the military population, DNBI remains less studied than battle injury. In this
review, we aimed to evaluate the recently published literature on DNBI and to describe the characteristics of these recently published studies.
METHODS: This systematic
review is reported in the Prospective Register of Systematic Reviews database. The systematic search for published articles was conducted through July 21, 2022, in Cumulative Index of Nursing and Allied Health, Cochrane Library, Defense Technical Information Center, Embase, and PubMed. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses, the investigators independently screened the reference lists on the Covidence website (covidence.org). An article was excluded if it met any of the following criteria: (1) Published not in English; (2) published before 2010; (3) data used before 2001; (4) case reports, commentaries, and editorial letters; (5) systematic reviews or narrative reviews; (6) used animal models; (7) mechanical or biomechanical studies; (8) outcome was combat injury or non-specified; (9) sample was veterans, DoD civilians, contractors, local nationals, foreign military, and others; (10) sample was U.S. Military academy; (11) sample was non-deployed; (12) bioterrorism study; (13) qualitative study. The full-text
review of 2 independent investigators reached 96% overall agreement (166 of 173 articles; κ = 0.89). Disagreements were resolved by a third reviewer. Study characteristics and outcomes were extracted from each article. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analysis of pooled estimates of incidence rates for disease (D), non-battle injury (NBI), and combined DNBI was created using random-effects models.
RESULTS: Of the 3,401 articles, 173 were included for the full
review and 29 (16.8%) met all inclusion criteria. Of the 29 studies included, 21 (72.4%) were retrospective designs, 5 (17.2%) were prospective designs, and 3 (10.3%) were surveys. Across all studies, the median number of total cases reported was 1,626 (interquartile range: 619.5-10,203). The results of meta-analyses for 8 studies with reported incidence rates (per 1,000 person-years) for D (n = 3), NBI (n = 7), and DNBI (n = 5) showed pooled incidence rates of 22.18 per 1,000 person-years for D, 19.86 per 1,000 person-years for NBI, and 50.97 per 1,000 person-years for combined DNBI. Among 3 studies with incidence rates for D, NBI, and battle injury, the incidence rates were 20.32 per 1,000 person-years for D, 6.88 per 1,000 person-years for NBI, and 6.83 per 1,000 person-years for battle injury.
CONCLUSIONS: DNBI remains the leading cause of morbidity in conflicts involving the U.S. Military over the last 20 years. More research with stronger designs and consistent measurement is needed to improve medical readiness and maintain force lethality.
METHODS: Systematic
Review and Meta-Analysis, Level III.