{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T20:40:05Z","timestamp":1758746405883,"version":"3.44.0"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"9-10","funder":[{"DOI":"10.13039\/100009898","name":"Defense Health Agency","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009898","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009898","name":"Defense Health Agency","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009898","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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\u2009months, but there was a very wide range of duty restriction durations, especially for SM with ER (median: 3\u2009months; interquartile range: 1, 8) and ECAST (median: 12; IQR: 3, 18). Duty restrictions were longer for younger SM (&amp;lt;26 vs \u226526\u2009years: 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).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usaf060","type":"journal-article","created":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T23:19:59Z","timestamp":1739834399000},"page":"e2220-e2226","source":"Crossref","is-referenced-by-count":0,"title":["Multidisciplinary Case Review Committee: Comprehensive Referral Source for Evaluation and Treatment of High-Risk Exertional Injuries Fostering Safe and Expeditious Return to Duty Decisions"],"prefix":"10.1093","volume":"190","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6186-3523","authenticated-orcid":false,"given":"Francesca","family":"Cariello","sequence":"first","affiliation":[{"name":"Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward H\u00e9bert School of Medicine, Uniformed Services University , Bethesda, MD 20814,","place":["USA"]},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, MD 20817,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4472-3994","authenticated-orcid":false,"given":"Melissa","family":"Rittenhouse","sequence":"additional","affiliation":[{"name":"Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward H\u00e9bert School of Medicine, Uniformed Services University , Bethesda, MD 20814,","place":["USA"]},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, MD 20817,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josh","family":"Kazman","sequence":"additional","affiliation":[{"name":"Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward H\u00e9bert School of Medicine, Uniformed Services University , Bethesda, MD 20814,","place":["USA"]},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, MD 20817,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Haigney","sequence":"additional","affiliation":[{"name":"Military Cardiovascular Outcomes Research Program, Department of Medicine, Uniformed Services University , Bethesda, MD 20814,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M Alaric","family":"Franzos","sequence":"additional","affiliation":[{"name":"Military Cardiovascular Outcomes Research Program, Department of Medicine, Uniformed Services University , Bethesda, MD 20814,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Glen","family":"Cook","sequence":"additional","affiliation":[{"name":"Autonomic Disorders Clinic, Department of Neurology, Walter Reed National Military Medical Center , Bethesda, MD 20814,","place":["USA"]},{"name":"Department of Neurology, Uniformed Services University , Bethesda, MD 20814,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey C","family":"Leggit","sequence":"additional","affiliation":[{"name":"Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward H\u00e9bert School of Medicine, Uniformed Services University , Bethesda, MD 20814,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francis G","family":"O\u2019Connor","sequence":"additional","affiliation":[{"name":"Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward H\u00e9bert School of Medicine, Uniformed Services University , Bethesda, MD 20814,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,3,1]]},"reference":[{"issue":"4","key":"2025092416174020200_R1","first-page":"3","article-title":"Heat Exhaustion and Heat Stroke Among Active Component Members of the U.S. Armed Forces, 2018-2022","volume":"30","author":"Armed Forces Health Services Division","year":"2023","journal-title":"MSMR"},{"key":"2025092416174020200_R2","doi-asserted-by":"publisher","DOI":"10.1186\/s13023-015-0264-3","article-title":"Rhabdomyolysis: a genetic perspective","volume":"10","author":"Scalco","year":"2015","journal-title":"Orphanet J Rare Dis"},{"key":"2025092416174020200_R3","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1136\/jmedgenet-2019-106461","article-title":"Investigating the genetic susceptibility to exertional heat illness","volume":"57","author":"Gardner","year":"2020","journal-title":"J Med Genet"},{"article-title":"DoD Health Care: Improvements Needed for Tracking Coordination of Specialty Care Referrrals for TRICARE Prime Beneficiaries","year":"2024","author":"United States Government Accountability Office","key":"2025092416174020200_R4"},{"issue":"9","key":"2025092416174020200_R5","doi-asserted-by":"publisher","first-page":"e1946","DOI":"10.7205\/milmed-d-16-00429","article-title":"International Classification of Disease Coding of Exertional Heat Illness in U.S. Army Soldiers","volume":"182","author":"DeGroot","year":"2017","journal-title":"Mil Med"},{"author":"Defense Health Agency","key":"2025092416174020200_R6","article-title":"Fiscal Year 2023-2028 Defense Health Agency Strategic Plan"},{"issue":"7\u20138","key":"2025092416174020200_R7","doi-asserted-by":"publisher","first-page":"e1193","DOI":"10.1093\/milmed\/usz463","article-title":"Military health system access to care: performance and perceptions","volume":"185","author":"Abiero","year":"2020","journal-title":"Mil Med"},{"issue":"9","key":"2025092416174020200_R8","doi-asserted-by":"publisher","DOI":"10.2196\/26220","article-title":"Virtual clinical and precision medicine tumor boards-cloud-based platform-mediated implementation of multidisciplinary reviews among oncology centers in the COVid-19 era: protocol for an observational study","volume":"10","author":"Blasi","year":"2021","journal-title":"JMIR Res Protoc"},{"issue":"6","key":"2025092416174020200_R9","doi-asserted-by":"publisher","first-page":"656","DOI":"10.1188\/18.Cjon.656-662","article-title":"Interprofessional lung cancer tumor board: the role of the oncology nurse navigator in improving adherence to National Guidelines and Streamlining Patient Care","volume":"22","author":"Peckham","year":"2018","journal-title":"Clin J Oncol Nurs"},{"article-title":"Consortium for Health and Military Performance","volume-title":"The Warrior Heat- and Exertion-Related Events Collaborative","author":"Uniformed Services University","key":"2025092416174020200_R10"},{"key":"2025092416174020200_R11","doi-asserted-by":"publisher","DOI":"10.3390\/genes15040408","article-title":"Genome-wide analysis of exertional rhabdomyolysis in sickle cell trait positive African Americans","volume":"15","author":"Ren","year":"2024","journal-title":"Genes"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/190\/9-10\/e2220\/62210052\/usaf060.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/190\/9-10\/e2220\/62210052\/usaf060.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T20:17:51Z","timestamp":1758745071000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/190\/9-10\/e2220\/8046646"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,1]]},"references-count":11,"journal-issue":{"issue":"9-10","published-online":{"date-parts":[[2025,3,1]]},"published-print":{"date-parts":[[2025,9,1]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usaf060","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"type":"print","value":"0026-4075"},{"type":"electronic","value":"1930-613X"}],"subject":[],"published-other":{"date-parts":[[2025,9]]},"published":{"date-parts":[[2025,3,1]]}}}