Development of Data-Driven Triage Systems for Identifying Mortally Wounded Casualties-Implications for Future Large-Scale Combat Operations

Sara Johnson; Ryann S Lauby; Michael D April; Joseph K Maddry; Luke Hofmann; Kevin Gillespie; Jose Salinas; Steven G Schauer

Development of Data-Driven Triage Systems for Identifying Mortally Wounded Casualties-Implications for Future Large-Scale Combat Operations

Med J (Ft Sam Houst Tex). 2022 Apr-Jun:(Per 22-04/05/06):32-39.

Authors

Sara Johnson¹, Ryann S Lauby¹, Michael D April², Joseph K Maddry³, Luke Hofmann⁴, Kevin Gillespie⁵, Jose Salinas⁵, Steven G Schauer⁶

Affiliations

¹ 59th Medical Wing, JBSA Lackland, TX.
² 40th Forward Resuscitation and Surgical Detachment, 627 Hospital Center, 1st Medical Brigade, Fort Carson, CO; and Uniformed Services University of the Health Sciences, Bethesda, MD.
³ 59th Medical Wing, JBSA Lackland, TX; Uniformed Services University of the Health Sciences, Bethesda, MD; US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX; and Brooke Army Medical Center, JBSA Fort Sam Houston, TX.
⁴ Uniformed Services University of the Health Sciences, Bethesda, MD; and Brooke Army Medical Center, JBSA Fort Sam Houston, TX.
⁵ US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX.
⁶ Uniformed Services University of the Health Sciences, Bethesda, MD; US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX; and Brooke Army Medical Center, JBSA Fort Sam Houston, TX.

PMID: 35373319

Abstract

Background: Uncontested air movement and advances for medical care of combat casualties have resulted in a decreased case fatality rate. However, in future large-scale combat operations, the military has established a plan for multidomain operations to defeat near-peer adversaries. Prolonged casualty care and mass casualty scenarios will become more prevalent. Prehospital friendly scoring systems such as the shock index (SI) and revised trauma score (RTS) may provide useful triage data. Development of accurate, data-driven, triage systems will be key to optimize management of resources, care, and transport of combat casualties.

Methods: We included data from the Department of Defense Trauma Registry between 01 January 2007 to 17 March 2020. Data comprised of adult US military or coalition service members for analysis as the baseline cohort, and those who died within 24 hours were included in the early death cohort. We performed statistical analysis on demographics and injury data, SI and RTS to measure the receiver operating characteristics (ROC) of each value to predict early death.

Results: The early death cohort had a significantly higher injury severity score (25 vs. 5) and a higher percentage of serious injuries in every body region than the baseline cohort. The early death cohort sustained serious injuries to the head and neck at a rate five times that of the baseline cohort (43.4% vs 8.1%) with odds ratio (OR) of death 8.0 (95% confidence interval 5.7-11.1) followed by skin (13.6% versus 1.9%) with an OR of 6.3 (95% CI 3.8-10.3). The mean SI was 1.21 versus 0.80. The revised trauma score (RTS) was 4.18 versus 7.34. The RTS had a higher area under the receiver operating characteristic (0.896 versus 0.716 for SI).

Conclusions: Serious injuries to the head and skin were most strongly associated with death within the first 24 hours. The RTS appears to be a more accurate tool than SI alone for assessing injury mortality. Military medical personnel should consider these factors when triaging casualties during future conflicts in resource limited settings with delayed evacuation.

Keywords: death; early; mortal; prehospital; transport; wounded.

MeSH terms

Adult
Humans
Injury Severity Score
Mass Casualty Incidents*
Military Personnel*
Shock*
Triage