title: Noncardiac chest pain during war.
abstract: 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.
authors.affiliation: Department of Anesthesiology, Johns Hopkins School of Medicine, 550 N. Broadway, Baltimore, MD 21029, USA. scohen40@jhmi.edu
authors.forename: Steven P
authors.initials: SP
authors.lastname: Cohen
authors.forename: Shruti G
authors.initials: SG
authors.lastname: Kapoor
authors.forename: Victoria C
authors.initials: VC
authors.lastname: Anderson-Barnes
authors.forename: Marie
authors.initials: M
authors.lastname: McHenry
authors.forename: Conner
authors.initials: C
authors.lastname: Nguyen
authors.forename: Dinesh
authors.initials: D
authors.lastname: Rao
authors.forename: Anthony
authors.initials: A
authors.lastname: Plunkett
mesh_terms: 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