Multidisciplinary Case Review Committee: Comprehensive Referral Source for Evaluation and Treatment of High-Risk Exertional Injuries Fostering Safe and Expeditious Return to Duty Decisions.

Abstract

Introduction: Exertion-related injuries (ERIs) affect Service Members (SM) worldwide with a direct impact on force readiness. Recent evidence has identified that the diagnostic coding of heat-related clinical illnesses can be subjective and prone to errors. Furthermore, ERIs, often have complex presentations impacting multiple organ systems. Optimal management, including establishing the correct diagnosis and plan for return to duty or disability evaluation system referral, frequently requires the expertise of multiple clinical specialties.

Materials and methods: This manuscript describes the function and process of the Consortium for Health and Military Performance (CHAMP) Multidisciplinary Case Review Committee (MDCRC), a multi-disciplinary clinical resource specifically focused on assisting clinicians with complex ERIs. To illustrate how the MDCRC works, we include methodology, and descriptive and inferential analysis of all MDCRC-referred cases.

Results: The MDCRC has evaluated 205 SM with complex exertional illness presentations; exertional rhabdomyolysis (ER; 53%), exertional heat illness (34%), exertional collapse associated with sickle cell trait (ECAST; 5%), cardiomyopathy (6%), or other exertion-related conditions. Most SMs (72%) successfully returned to duty within 3 months, but there was a very wide range of duty restriction durations, especially for SM with ER (median: 3 months; interquartile range: 1, 8) and ECAST (median: 12; IQR: 3, 18). Duty restrictions were longer for younger SM (<26 vs ≥26 years: risk ratio [RR]: 1.49, 95% CI: 0.98, 2.29) and history of multiple ERIs (RR: 1.69; 95% CI: 1.07, 2.62).

Conclusions: The MDCRC is a coordinated and comprehensive resource for all military health care practitioners and SM providing the most up-to-date evidence based clinical expertise for ERIs. MDCRC assists with proper diagnosis, facilitates expedited evaluations to optimize return to duty decisions, and increases SM readiness. MDCRC may be especially crucial for providers who have limited resources and experience in treating SM with ERIs.