title: Long-term impact of battle injuries; five-year follow-up of injured Dutch servicemen in Afghanistan 2006-2010.
abstract: OBJECTIVE
  Units deployed to armed conflicts are at high risk for exposure to combat events. Many battle casualties (BCs) have been reported in the recent deployment to Afghanistan. The long-term impact of these combat injuries, at their five-year end point, is currently unknown. To date, no systematic inventory has been performed of an identified group of BCs in comparison to non-injured service members from the same operational theatre.
  
  
  METHODS
  Observational cross-sectional cohort study.
  
  
  METHODS
  Open online survey among Dutch BCs that deployed to Afghanistan (2006-2010).
  
  
  METHODS
  The Dutch BCs (n = 62) were compared to two control groups of non-injured combat groups (battle exposed [n = 53], and non-battle exposed [n = 73]).
  
  
  METHODS
  Participants rated their impact of trauma exposure (Impact of Events [IES]), post deployment reintegration (Post Deployment Reintegration Scale [PDRS]), general symptoms of distress (Symptom Checklist 90 [SCL-90]), as well as their current perceived quality of life (EuroQol-6D [EQ-6D]). Also cost effectiveness (Short From health survey [SF-36]) and care consumption were assessed (Trimbos/iMTA questionnaire).
  
  
  RESULTS
  Over 90% of BCs were still in active duty. The mean scores of all questionnaires (IES, EQ-6D, SF-36, and SCL-90) of the BC group were significantly higher than in the control groups (p<0.05). The PDRS showed a significantly lower (p<0.05) outcome in the negative subscales. The mean consumption of care was triple that of both control groups. A lower score on quality of life was related to higher levels of distress and impact of trauma exposure.
  
  
  CONCLUSIONS
  This study showed a clear long-term impact on a wide range of scales that contributes to a reduced quality of life in a group of BCs. Low perceived cost effectiveness matched with high consumption of care in the BC group in comparison to the control groups. These results warrant continuous monitoring of BCs.
authors: Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors: Rigo
authors: R
authors: Hoencamp
authors: Department of Surgery, Medical Centre Haaglanden, The Hague, The Netherlands.
authors: Floris J
authors: FJ
authors: Idenburg
authors: Department of Surgery, University Medical Centre, Utrecht, The Netherlands.
authors: Thijs T C F
authors: TT
authors: van Dongen
authors: Department of Physiatrist, Rehabilitation Center de Hoogstraat, Utrecht, The Netherlands.
authors: Loes G M
authors: LG
authors: de Kruijff
authors: Department of Surgery, University Medical Centre, Utrecht, The Netherlands.
authors: Eelco P
authors: EP
authors: Huizinga
authors: Force Health Protection, Expert Centre Force Health Protection Ministry of Defense, Utrecht, The Netherlands.
authors: Marie-Christine J
authors: MC
authors: Plat
authors: Leiden University Medical Centre, Leiden, The Netherlands.
authors: Erik
authors: E
authors: Hoencamp
authors: Department of Surgery, University Medical Centre, Utrecht, The Netherlands.
authors: Luke P H
authors: LP
authors: Leenen
authors: Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors: Jaap F
authors: JF
authors: Hamming
authors: Leiden University Medical Centre, Military Mental Health Research, Utrecht, The Netherlands.
authors: Eric
authors: E
authors: Vermetten
mesh_terms: D000293:Adolescent; D000328:Adult; D000346:Afghanistan; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008887:Military Medicine; D008889:Military Personnel / Q000706:statistics & numerical data*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries; D055815:Young Adult
references: Injury. 2015 May;46(5):863-9
references: 25548112
references: World J Surg. 2014 Oct;38(10):2551-7
references: 24844658
references: J Clin Epidemiol. 1998 Nov;51(11):1055-68
references: 9817123
references: Lancet. 2006 May 27;367(9524):1731-41
references: 16731268
references: Mil Med. 2014 Mar;179(3):265-72
references: 24594460
references: BMC Public Health. 2011;11:69
references: 21281496
references: Psychopharmacol Bull. 1973 Jan;9(1):13-28
references: 4682398
references: Br J Psychiatry. 2005 Jun;186:476-9
references: 15928357
references: Eur J Psychotraumatol. 2014 Aug 14;5:null
references: 25206952
references: Mil Med. 2009 Jul;174(7):689-94
references: 19685839
references: J Vasc Surg. 2014 Jan;59(1):173-9.e1
references: 24041802
references: Health Policy. 1990 Dec;16(3):199-208
references: 10109801
references: Injury. 2014 Jul;45(7):1028-34
references: 24878294
references: J R Army Med Corps. 2008 Jun;154(2):124-7
references: 19043994
references: Behav Res Ther. 2003 Dec;41(12):1489-96
references: 14705607
references: Lancet. 2010 May 22;375(9728):1783-97
references: 20471076
references: World J Surg. 2014 Jul;38(7):1713-8
references: 24481991
references: J Gen Intern Med. 2012 Sep;27(9):1200-9
references: 22648608
references: Soc Work Health Care. 2011;50(7):515-26
references: 21846252
references: Mil Med. 2014 Jan;179(1):12-8
references: 24402979
references: Mil Med. 2014 Apr;179(4):348-55
references: 24690957