Noncardiac chest pain during war.
OBJECTIVE
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.
Cohen
Steven P
SP
Department of Anesthesiology, Johns Hopkins School of Medicine, 550 N. Broadway, Baltimore, MD 21029, USA. scohen40@jhmi.edu
Kapoor
Shruti G
SG
Anderson-Barnes
Victoria C
VC
McHenry
Marie
M
Nguyen
Conner
C
Rao
Dinesh
D
Plunkett
Anthony
A
D000328:Adult; D002637:Chest Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D003130:Combat Disorders / Q000453:epidemiology; D017281:Cost of Illness; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D008887:Military Medicine; D008889:Military Personnel / Q000523:psychology; D015999:Multivariate Analysis; D011446:Prospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014857:Warfare