@article{ref1,
title="Analysis of non-battle deaths among U.S. service members in the deployed environment",
journal="Annals of surgery",
year="2021",
author="Le, Tuan D. and Gurney, Jennifer M. and Akers, Kevin S. and Chung, Kevin K. and Singh, Karan P. and Wang, Heuy-Ching and Stackle, Mark E. and Pusateri, Anthony E.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="OBJECTIVE: Describe etiologies and trends in non-battle deaths (NBD) among deployed U.S. service members to identify areas for prevention. <br><br>BACKGROUND: Injuries in combat are categorized as battle (result of hostile action) or non-battle related. Previous work found that one-third of injured US military personnel in Iraq and Afghanistan had non-battle injuries (NBI) and emphasized prevention. NBD have not yet been characterized. <br><br>METHODS: U.S. military casualty data for Iraq and Afghanistan from 2001-2014 were obtained from the Defense Casualty Analysis System (DCAS) and the Department of Defense Trauma Registry (DoDTR). Two databases were used because DoDTR does not capture pre-hospital deaths, while DCAS does not contain clinical details. NBI and NBD were identified, etiologies classified, and NBD trends were assessed using a weighted moving average and time-series analysis with autoregressive integrated moving average. Future NBD rates were forecast. <br><br>RESULTS: DCAS recorded 59,799 casualties; 21.0% (n=1,431) of all deaths (n=6,745) were NBD. DoDTR recorded 29,958 casualties; 11.5% (n=206) of all deaths (n=1788) were NBD. After early fluctuations, NBD rates for both Iraq and Afghanistan stabilized at approximately 21%. Leading causes of NBD were gunshot wounds and vehicle accidents, accounting for 66%. Approximately 25% was self-inflicted. A 24% NBD rate was forecasted from 2015 through 2025. <br><br>CONCLUSIONS: Approximately 1 in 5 deaths were NBD. The majority were potentially preventable, including a significant proportion of self-inflicted injuries. A single comprehensive data repository would facilitate future mortality monitoring and performance improvement. These data may assist military leaders with implementing targeted safety strategies.<p /> <p>Language: en</p>",
language="en",
issn="0003-4932",
doi="10.1097/SLA.0000000000005047",
url="http://dx.doi.org/10.1097/SLA.0000000000005047"
}