Injury Surveillance in the Canadian Forces
Dr. Jeff Whitehead Epidemiology Section, D FHP
23 June 2008 CF HP National WG in IP and AL
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Outline
1. 2. 3. 4. 5. 6. Mortality database Health and Lifestyle Information Survey (HLIS) Retrospective chart review on injuries in the CF Sick Leave Database Summary of Findings to Date Prospective Injury Surveillance and Intervention Pilot
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Mortality Database
• DFHP collects data on all CF deaths since 2004 • Review medical record, Summary Investigation/Board of Inquiry, and if needed discuss with Base/Wing Surgeon to identify cause of death and preventability • To date, 2004 and 2005 data collection are complete
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CF Mortality 2004 and 2005
Demographics • 91 deaths ( 86 male, 5 female)
• 25% (23 deaths) due to unintentional injuries
• All males with average age of 30 years
• Nearly half (11 deaths of the 23) were transportrelated
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Health and Lifestyle Information Survey
• Stratified random sample of Regular Force and Reserve Force members in separate surveys • Results discussed here relate to Regular Force report only • Mailed to 5036 CF members of which 3019 responded (response rate of 60%) • Direct standardization using the CF 2004 population was used to compare the HLIS 2000 to the 2004 survey
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Acute Injury Definition
A sudden transfer of energy or an acute exposure to a substance that exceeds the threshold of human tolerance. In HLIS 2004 “injuries serious enough to limit normal activities in the past 12 months, such as a broken bone, a bad cut or burn, or a sprain”.
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HLIS Acute Injuries
• CF incidence: 28% in 2000; 26% in 2004 • Canadian Population Incidence: 14% in 2000; 13% in 2004
Sex-specific Age Standardized Rates of Acute Injuries in a 1 yr period
40% 30% 20% 10% 0% Males
*standardized to the 2004 male CF population
40%
28%
28% HLIS 2000 HLIS 2004
30% 20% 10% 0%
27%
23% HLIS 2000 HLIS 2004
Females
*standardized to the 2004 female CF population
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HLIS 2004 - Acute Injuries
• Average number of injuries – 1.75 (median 1, range 1-30) per person
• Rates highest in younger members
– males 30-34 yrs (36%); females 20-29 yrs (31%)
• Rates higher in junior NCMs (28%) and junior officers (31%) • Element - 30% Land, 26% Sea, 22% Air
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Type of Acute Injury in the Past 12 Months
Type of Injury
Sprain or strain
Broken or fractured bones Dislocation Scrape, bruise, blister Cut, puncture, animal bite Multiple Injuries Burn, scald, chemical burn Concussion or other brain injuries Injury to internal organs Poisoning Other
--- numbers too small to report
Total %
57
12 4 4 3 ----------16
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Activity when Acute Injury Occurred
Activity Sports/PT/Adventure training Other paid military duties (at work) Military training/involved in a military exercise Leisure (not sports/PT/Adventure training) M (%) 53 15 10 6 F (%) 45 10 17 7 Total (%) 52 15 11 6
Other
Unpaid work (household, volunteer, education, etc.) Battle related activity Traveling (includes travel to and from work) Paid civilian work
--- numbers too small to report
5
---------
9
---------
5
4 4 3 ---
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Repetitive Strain Injury Definition
Any injury caused by overuse or repeating the same movement frequently (such as carpal tunnel syndrome, tennis elbow, plantar fasciitis) that limited normal activities in the past 12 months.
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HLIS Repetitive Strain Injuries
• CF incidence: 24% in 2000; 27% in 2004 • Canadian population incidence: 12% in 2003, 12% 2000
Sex-specific Age Standardized Rates of RSIs Sustained over a 1 yr period
40% 30% 20% 10% 0% Male CF Members
*standardized to the 2004 male CF population
40%
24%
26% HLIS 2000 HLIS 2004
30% 20% 10% 0%
25%
30% HLIS 2000 HLIS 2004
Female CF Members
*standardized to the 2004 female CF population
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Activity when RSI Injury Occurred
Activity Sports/PT/Adventure training Other paid military duties (at work) Military training/involved in a military exercise Unpaid work (household, volunteer, education, etc.) M (%) 59 34 25 7 F (%) 50 36 23 7 Total (%) 58 34 25 7
Battle related activity
Leisure (not sports/PT/Adventure training) Other Traveling (includes travel to and from work) Paid civilian work
--- numbers too small to report
6
6 6 2 ---
4
6 9 1 ---
6
6 6 2 ---
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Retrospective Chart Review of Injuries in the CF
• Convenience sample: four bases (CFB Halifax, CFB Trenton, CFB Petawawa and NDHQ) sampled; stratified by base and sex • Retrospective health record review between 1998 and 2002 • Sample size = 1938 health records reviewed
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Incidence
Injury Type All injuries Acute Injuries Repetitive Strain Injuries RSIs and Unknown injury types Incidence density & 95% CI / per 100 pys 75.7 (75.7 – 82.9) 47.6 (44.9 – 50.3) 24.7 (23.1 – 26.2) 31.7 (29.9 – 33.4)
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Injuries in CF members
• Of 15,809 CF members, at least 13,494 (85%) had at least one injury. • 15, 809 members sustained a total of 53,553 injuries during the 5-year period
– 60% Acute injuries – 31% RSIs – 9% Unknown type
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Acute Injury Incidence by Base
CFB Petawawa Incidence per 100 pys 79.4 (72.0 – 86.8) CFB Halifax 42.7 (38.2 – 47.2) CFB Trenton 40.9 (36.8 – 45.1) NDHQ 23.4 (20.5 – 26.3)
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Acute Injury Incidence by Base and Sex
Incidence per 100 pys Male CFB Petawawa 79.9 (71.7 – 88.1) 74.7 (66.3 – 83.0) CFB Halifax 42.2 (37.3 – 47.1) 47.6 (42.3 – 52.9) CFB Trenton 40.8 (36.1 – 45.5) 41.6 (36.9 – 46.1) NDHQ 22.9 (19.6 – 26.1) 27.4 (24.2 – 30.5)
Female
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Acute Injury Incidence by Base and Age
Age 17-29 30-34 35-39 40-54 CFB Petawawa 93.8 (81.8-105.8) 75.7 (62.7-88.8) 62.9 (49.7-76.2) 54.7 (26.8-82.7) CFB Halifax 53.8 (43.6-64.1) 47.9 (38.3-57.5) 43.7 (35.4-52.1) 26.2 (20.0-32.4) CFB Trenton 46.8 (36.2-57.4) 45.3 (35.3-55.4) 35.5 (29.7-41.3) 40.7 (32.7-48.6) NDHQ 29.0 (19.3-38.6) 39.2 (25.9-52.5) 22.8 (17.8-27.8) 19.2 (16.1-22.4)
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Acute Injury Incidence by Base and Rank
Snr Offr Jnr Offr SNCM JNCM CFB Petawawa 42.0 (19.3-64.8) 35.9 (21.8-49.9) 55.4 (43.0-67.8) 94.1 (84.7-103.5) CFB Halifax 25.8 (16.5-35.0) 25.2 (17.1-33.2) 30.5 (24.6-36.5) 58.1 (50.7-65.5) CFB Trenton 33.3 (15.4-51.1) 26.0 (20.3-31.8) 33.4 (27.1-39.7) 49.8 (43.4-56.2) NDHQ 19.9 (16.3-23.6) 27.7 (21.6-33.8) 24.5 (18.9-30.2) 40.7 (19.4-62.1)
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Most Common Body Region Injured
• 65.3% - Extremities (33.3% lower extremity, 32.0% upper extremity)
• 12.2% - Vertebral column • 10.9% - Head and neck
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Mechanism of Acute Injury by Sex
• • • • Males 31.6% - Over-exertion 23.1% - Struck by or against 16.1% - Fall 7.8% - Cut/pierce • • • • Females 33.9% - Over-exertion 24.6% - Fall 16.4% - Struck by or against 5.2% - Cut/pierce
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Severity of Acute Injuries
• 55.9% Minor (superficial e.g. bruises, minor cuts) • 43.8% Moderate (required some skilled treatment) • 0.30% Severe (requiring intensive medical/surgical management)
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RSI Incidence Density by Base
CFB Petawawa Incidence per 100 pys 40.0 (35.9 – 44.0) CFB Halifax 22.1 (19.4 – 24.8) CFB Trenton 18.3 (15.8 – 20.8) NDHQ 15.8 (14.0 – 17.7)
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RSI Incidence by Base and Sex
Incidence per 100 pys Male CFB Petawawa 37.8 (33.4 – 42.2) 58.5 (52.4 – 64.6) CFB Halifax 21.1 (18.2 – 24.0) 32.3 (28.8 – 35.9) CFB Trenton 17.4 (14.6 – 20.2) 24.1 (21.0 – 27.2) NDHQ 15.1 (13.0 – 17.2) 21.1 (18.6 – 23.7)
Female
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RSI Incidence by Base and Age
Age 17-29 30-34 35-39 40-54 CFB Petawawa 45.0 (38.7-51.3) 36.0 (29.0-43.0) 34.6 (27.0-42.2) 39.6 (19.6-59.6) CFB Halifax 22.5 (17.1-27.8) 22.8 (16.7-28.9) 24.3 (18.4-30.3) 19.1 (15.0-23.3) CFB Trenton 17.6 (12.3-22.9) 20.7 (14.4-27.0) 16.3 (12.8-19.7) 20.4 (14.5-26.3) NDHQ 15.9 (9.3-22.5) 17.5 (12.2-22.9) 14.2 (11.0-17.4) 16.2 (13.6-18.9)
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RSI Incidence by Base and Rank
Snr Offr Jnr Offr SNCM JNCM CFB Petawawa 15.5 (8.0-23.0) 29.5 (21.0-38.0) 32.4 (24.1-40.7) 44.6 (39.5-49.6) CFB Halifax 10.4 (5.1-15.6) 18.4 (12.1-24.6) 17.4 (13.7-21.2) 27.9 (23.4-32.4) CFB Trenton 11.0 (4.4-17.7) 16.1 (9.0-23.2) 18.3 (13.3-23.4) 19.6 (16.4-22.9) NDHQ 14.2 (11.6-16.7) 19.1 (14.2-23.9) 16.3 (12.7-19.9) 21.6 (13.7-29.6)
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Sick Leave Database
• In 2002, data from the CF human resources database (PeopleSoft data) suggested that rates of sick leave were also increasing in the CF • PeopleSoft data does not contain detailed medical information and was limited to identifying general sick leave trends • The Surgeon General initiated the development of the CF sick leave database to collect more detailed sick leave data
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Sick Leave Database
• Implemented in 2003 • ACCESS database • Sick leave inputted into database by clerks and administrators at CF medical clinics • 14 diagnosis categories (5-20 diagnoses per category) • 210 possible diagnoses
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Proportion of sick leave days by diagnosis
PSYCH
46%
GI
4% 5% 14%
22%
MSK
OB/GYN MISC
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Summary of Findings to Date
• Injuries are a leading cause of mortality in the CF • Acute injuries and repetitive strain injury rates are twice as high compared to the Canadian population • Acute injuries are higher in younger members, land element, and a substantial proportion occur during sport/PT related activities. • Acute injuries are more likely to occur in the lower extremities and be related to muscles, tendons, ligaments, and cartilage
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Summary of Findings to Date
• Injuries are a leading cause of loss of time from work for medical reasons (annual cost $5-35 million) • Specific injury prevention planning requires detailed injury surveillance to include mechanism and activity at the time • This is not well captured in medical charts or elsewhere • An injury surveillance system is required to collect and analyze data and disseminate information on a timely and ongoing basis for policy development and for targeted prevention programs and evaluation
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The Prospective Injury Surveillance Pilot
• Will be funded through the Health and Physical Fitness Strategy for trial at one base • Patterned after Australian Defence Force system • CF members presenting with an injury at medical treatment facilities will fill out a detailed questionnaire, diagnosis to be added by clinician • Non-medical data will be shared with DSafeG and DCSA, information with all partners
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The Prospective Injury Surveillance Pilot
• Data will be analyzed in Ottawa and sent back to base • Project coordinator (ideally a physiotherapist) at base level as well as a clerk to assist with data collection • Having detailed injury data in hand, project coordinator will work with the units to identify preventive interventions • 3 year pilot, if successful would hope to roll this out to other bases
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SUMMARY
• The CF has a high rate of acute injuries and repetitive strain injuries • The financial cost from lost time alone is between $5 and $35 million dollars annually • The majority of the injuries are sports/PT related • Prevention of these injuries requires details of activity and mechanism • A pilot surveillance and intervention program will test our ability to decrease this burden on the health of CF members
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