Rhabdomyolysis in the US Active Duty Army, 2004-2006

PURPOSE: Rhabdomyolysis (RM) is a skeletal muscle disorder resulting in severe cellular injury caused by vigorous physical activity and other systemic etiologies. RM is associated with significant morbidity, such as acute renal failure, and can be fatal. RM that occurs in the US Active Duty Army (ADA) results in time lost from training, deployment, and combat. We sought to systemically describe the epidemiology of ADA clinical RM by quantifying RM in terms of absolute numbers, examine rate trends, and identify soldiers at elevated risk. METHODS: We used data from the Total Army Injury and Health Outcomes Database to calculate yearly RM rates in the overall ADA, as well as adjusted RM rates within soldier subpopulations for 2003-2006. RESULTS: During this period, the absolute numbers of clinically diagnosed ADA RM ranged between 382 and 419 cases per year. Annual rates were 7-8 per 10, 000, which is 300%-400% higher than the estimated US civilian population (2 per 10, 000). In soldiers with a history of a prior heat injury, RM rates climbed to 52-86 per 10, 000, a 7- to 11-fold increase. Increased RM rates were seen in soldiers who are male, African American, younger, less educated, and with a shorter length of service. Approximately 8% of yearly ADA RM cases resulted in acute renal failure, an estimate lower than that for the US civilian population. CONCLUSIONS: Our findings suggest that rates of RM are higher in the ADA than in the US civilian population. Rates remained fairly stable; however, relative to other ADA soldiers, those with prior heat injury, who are African American, or who have a length of service of less than 90 d are at the highest risk for RM development.