Activity ID



September 19, 2021

Format Type

Journal-based CME

CME Credit



CME Provider

JAMA Surgery


Nonbattle injury (NBI) among deployed US service members increases the burden on medical systems and results in high rates of attrition, affecting the available force. The possible causes and trends of NBI in the Iraq and Afghanistan wars have, to date, not been comprehensively described.

To describe NBI among service members deployed to Iraq and Afghanistan, quantify absolute numbers of NBIs and proportion of NBIs within the Department of Defense Trauma Registry, and document the characteristics of this injury category.

Design, Setting, and Participants:
In this retrospective cohort study, data from the Department of Defense Trauma Registry on 29?958 service members injured in Iraq and Afghanistan from January 1, 2003, through December 31, 2014, were obtained. Injury incidence, patterns, and severity were characterized by battle injury and NBI. Trends in NBI were modeled using time series analysis with autoregressive integrated moving average and the weighted moving average method. Statistical analysis was performed from January 1, 2003, to December 31, 2014.

Main Outcomes and Measures:
Primary outcomes were proportion of NBIs and the changes in NBI over time.

Among 29?958 casualties (battle injury and NBI) analyzed, 29 003 were in men and 955 were in women; the median age at injury was 24 years (interquartile range, 21-29 years). Nonbattle injury caused 34.1% of total casualties (n?=?10 203) and 11.5% of all deaths (206 of 1788). Rates of NBI were higher among women than among men (63.2% [604 of 955] vs 33.1% [9599 of 29 003]; P?P?P?

Conclusions and Relevance:
In this study, approximately one-third of injuries during the Iraq and Afghanistan wars resulted from NBI, and the proportion of NBIs was steady for 12 years. Understanding the possible causes of NBI during military operations may be useful to target protective measures and safety interventions, thereby conserving fighting strength on the battlefield.


1. This activity is accredited by the American Medical Association.
2. This activity is free to AMA members.

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Educational Objectives

Educational Objective To identify the nonbattle injuries (NBIs) seen in US service members in Iraq and Afghanistan.


Surgery, Trauma and Injury, Violence, War


Medical Knowledge

CME Credit Type

AMA PRA Category 1 Credit



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