Epidemiology of musculoskeletal injuries of U.S. Coast Guard Academy cadets during initial military training from 2018 to 2023

Abstract: INTRODUCTION: Musculoskeletal Injuries (MSKIs) have a longstanding deleterious impact on the health of service members (SMs) and the readiness of the armed services. Although active duty branches of the military have reported historical injury rates and descriptive statistics, less is known about other armed services populations. Cadets at service academies undergo similar initial military training (IMT) as their active duty counterparts, however, rates and risk factors for sustaining a MSKI during training and its impact on the cadet are less known. The purpose of this study, therefore, was to evaluate MSKI during IMT at the U.S. Coast Guard Academy (USCGA). MATERIALS AND METHODS: Retrospective MSKI data from 2018 to 2023 was used to calculate descriptive statistics of MSKIs sustained during USCGA IMT, which is the 7-week introductory training before matriculation at the USCGA. Incidence rates were calculated as the number of exposed (injured) cadets divided by the total number of cadets and multiplied by the exposure period of interest (person-weeks). Incidence rate was assessed for each year of observation (7-week period) as well as for each week of IMT to identify trends in injury rate. Factors most frequently associated with MSKI were assessed for significance with multiple regression. Differences in injury risk between sex were assessed via risk ratio with confidence intervals. Descriptive statistics were provided for body region, mechanism of injury, and other available metrics. RESULTS: The cumulative incident rate was 65.98 MSKI per 1,000 person-weeks during IMT across 2018-2023, with 31.2% of all cadets sustaining an MSKI. Females had a 50% greater risk of injury than males for each year of observation (Risk Ratio (RR) = 1.49, 95% CI). The lower extremity was the most frequently injured body region (66.9%) and most MSKIs were sustained doing training-related activities. Factors significantly associated with the presence of MSKI included sex, history of prior injury, and medical waiver for admission. CONCLUSION: Rates of MSKI are similar among cadets at service academies as active duty SMs undergoing IMT. Further investigation is warranted to have a better understanding of risk factors for injury and long-term outcomes associated with early career MSKI. Cadets at service academies should also be considered for future injury prevention initiatives given the high rate of MSKI among this population.