Descriptive Analysis of Casualties Rapidly Returned to the Fight after Injury: Reverse Triage Implications for Large...

During large scale combat operations, rising numbers of casualties will likely outstrip in-theater US military medical hospitalization assets. This highlights the importance of identifying those casualties who can return to the fight in order to minimize further medical resource depletion. We describe specific characteristics of casualties returned to duty without requiring evacuation from theater during recent major combat operations.

We conducted a secondary analysis of previously published data from the Department of Defense Trauma Registry during 01 January 2007 through 17 March 2020. We included all adult US military casualties. We categorized casualties according to documented disposition, namely, return to duty within 72 hours without evacuation from theater, return to duty greater than 72 hours without evacuation from theater, and all other casualties.

Of 10,182 adult US military casualties, 3,856 (37.9%) returned to duty within 72 hours without evacuation from theater and 220 (2.2%) returned to duty in greater than 72 hours without evacuation from theater. The cohort that rapidly returned to duty had a lower median injury severity score (2) than casualties returning to duty in greater than 72 hours (4) and those evacuated from theater (11). Notably higher proportions of casualties evacuated from theater sustained injuries to the face, thorax, abdomen, and extremities. Modes of transportation were similar across all three groups, though casualties undergoing evacuation from theater were more likely to undergo air transportation during the spectrum of their medical care.

Most combat casualties returning to duty without evacuation from theater did so within 72 hours of hospitalization. Casualties not requiring evacuation from theater were less likely to sustain injuries to the face, thorax, abdomen, and extremities.