Severe Upper Limb Injuries in U.S. Military Personnel: Incidence, Risk Factor and Outcomes

Colleen A. Daniels, Cara H. Olsen, Ann I. Scher, Patricia L. McKay, David W. Niebuhr

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background: Severe upper limb injuries (SULI) may pose a significant public health challenge for the military; however, SULI has not been previously defined or studied in the US military. Objective: Determine SULI incidence, risk factors, and outcomes. Materials and Methods: Active Component (AC) U.S. military personnel who served during January 1, 2003 to December 31, 2012 who met the case definition for SULI (N = 213,745) and a random sample from the same population without SULI were included. Data from the Defense Medical Surveillance System and Defense Medical Epidemiology Database was used to calculate incidence. Multiple logistic regression and Cox proportional hazards models were used to analyze SULI risk factors and attrition. Results: SULI incidence was 15/1,000 person-years. Higher SULI risk was observed in men (OR 1.25; 95% CI 1.22-1.27), age 25-29 (OR 1.07; 95% CI 1.05-1.09) compared to age 20-24, E5-E9 (OR 1.14; 95% CI 1.12-1.17) compared to E1-E4, serving in Coast guard (OR 1.62; 95% CI 1.56-1.68) and Air Force (OR 1.17; 95% CI 1.14-1.19) relative to Army and with a deployment history (OR 2.16, 95% CI 2.12-2.19) while SULI risk was lower for blacks (OR 0.91; 95% CI 0.90-0.93) and those in the "other race" category (HR 0.81; 95% CI 0.80-0.84) compared to whites. SULI was associated with 23% increased risk of attrition (HR 1.23; 95% CI 1.22-1.24). Conclusion: The study findings provide preliminary evidence on the incidence, natural history and distribution of SULI in this population. The findings indicate SULI may impact readiness and result in premature military separation.

Original languageEnglish
Pages (from-to)E146-E153
JournalMilitary Medicine
Issue number1-2
StatePublished - 12 Feb 2020
Externally publishedYes


  • Attrition
  • Incidence
  • Risk Factors
  • Severe Upper Limb Injury


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