Development of Data-Driven Triage Systems for Identifying Mortally Wounded Casualties-Implications for Future...

Area of Science:

• Military Medicine
• Trauma Surgery
• Emergency Medicine

Background:

• Advances in medical care have decreased combat casualty mortality.
• Future large-scale combat operations may involve prolonged casualty care and mass casualty scenarios.
• Accurate, data-driven triage systems are crucial for optimizing resource management and casualty care.

Purpose of the Study:

• To evaluate the predictive accuracy of the Shock Index (SI) and Revised Trauma Score (RTS) for early death in combat casualties.
• To identify key injury patterns associated with mortality within 24 hours of injury.

Main Methods:

• Analysis of data from the Department of Defense Trauma Registry (2007-2020).
• Inclusion of adult US military or coalition service members.
• Statistical analysis of demographics, injury data, SI, and RTS to determine receiver operating characteristics (ROC) for predicting early death.

Main Results:

• The early death cohort had significantly higher injury severity scores and a higher incidence of serious injuries across all body regions.
• Serious head and neck injuries (43.4% vs 8.1%) and skin injuries (13.6% vs 1.9%) were strongly associated with early death.
• The Revised Trauma Score (RTS) demonstrated higher predictive accuracy (AUC 0.896) compared to the Shock Index (SI) (AUC 0.716).

Conclusions:

• Head and skin injuries are the strongest predictors of death within 24 hours.
• The RTS is a more accurate triage tool than SI alone for assessing combat casualty mortality.
• Military medical personnel should utilize RTS and consider injury patterns for triage in resource-limited settings with delayed evacuation.