title: Clinical prediction of musculoskeletal-related "medically not ready" for combat duty statuses among active duty U.S. army soldiers.
abstract: No evidence-based mechanism currently exists to inform U.S. Army clinicians of soldiers at risk of being found "Medically Not Ready" for combat duty. Historically, musculoskeletal conditions represent high-frequency medical problems among Army soldiers. We explored the feasibility of using centrally archived medical and administrative data on Army soldiers in the automated prediction of musculoskeletal-related Medically Not Ready soldiers who did not deploy. We examined 56,443 active duty U.S. Army soldiers who underwent precombat medical screening during March through December 2009 and in March 2010. Musculoskeletal problems were associated with 23.0% of nonreadiness cases in the study population. We used multivariable logistic regression in derivation cohorts to compute risk coefficients and cut points. We then applied these coefficients to covariates in validation cohorts, simulating predictions 2 to 3 months before their medical screenings. The analysis yielded c statistics ranging from 83 to 90%. The predictions identified 45 to 73% and 50 to 82% of the individual male and female outcome-positive soldiers, respectively, while obtaining 83 to 95% specificity. Our findings demonstrate the potential of Army data to create evidence-based estimates of nonreadiness risk. These methods could enable earlier patient referrals and improved management, and potentially reduce medically related nondeployment.
authors.affiliation: Decision Support Center, Office of the Army Surgeon General, Defense Health Headquarters, 7700 Arlington Boulevard, Falls Church, VA 22042.
authors.forename: D Alan
authors.initials: DA
authors.lastname: Nelson
authors.forename: Lianne M
authors.initials: LM
authors.lastname: Kurina
mesh_terms: D000328:Adult; D016208:Databases, Factual; D020000:Decision Support Systems, Clinical; D005260:Female; D005544:Forecasting / Q000379:methods; D006801:Humans; D016015:Logistic Models; D008297:Male; D008889:Military Personnel; D009140:Musculoskeletal Diseases / Q000175:diagnosis*; D012372:ROC Curve; D012189:Retrospective Studies; D014481:United States; D014938:Work Capacity Evaluation; D055815:Young Adult