Military aeromedical evacuations from Central and Southwest Asia for ill-defined dermatologic diseases

Abstract

Objectives: To determine the diagnoses of US military patients medically evacuated from Central and Southwest Asia for ill-defined dermatologic diseases, to compare these diagnoses with data from earlier military conflicts, and to identify ways to reduce the number of dermatologic evacuations of military personnel from the combat zone. Design: We evaluated the preevacuation and post-evacuation diagnoses of military personnel who were evacuated from Central and Southwest Asia for ill-defined dermatologic conditions. Outside the combat zone, these individuals were examined by dermatologists who provided a diagnosis regarded as correct for the purposes of this study. We excluded patients with precise pre-evacuation diagnoses, battle-related cutaneous injuries, and incomplete identifying data. Setting: The geographic area of responsibility for the US Central Command, including Iraq and Afghanistan. Data from January 1, 2003, through December 31, 2006, were obtained from aeromedical evacuation records and the military's electronic medical records system. Patients: A total of 170 patients evacuated from the combat zone for ill-defined dermatologic diseases, such as skin disorder, not otherwise specified (International Classification of Diseases, Ninth Revision, Clinical Modification code 709.9). Main Outcome Measures: The postevacuation diagnosis assigned, in nearly all cases, by a board-certified dermatologist. Results: Dermatitis, benign melanocytic nevus, malignant neoplasms, benign neoplasms, urticaria, and a group of nonspecific diagnoses were the most common post-evacuation diagnoses. Conclusions: We propose that thorough pre-deployment identification of individuals with chronic skin diseases, emphasis of preventive measures, and development of treatment plans will reduce the number of dermatologic evacuations. Improving diagnostic accuracy and treatment plans via teledermatology may also reduce evacuations. The most common dermatologic diseases leading to evacuations are similar to those from 20th century wars. ©2009 American Medical Association. All rights reserved.