High-Accuracy Performance of a Simplified Binary Triage System in Military Trauma

Area of Science:

• Military Medicine
• Trauma Surgery
• Emergency Medicine

Background:

• Accurate prehospital triage is crucial in combat settings due to diagnostic uncertainty and resource limitations.
• Simplified triage systems enhance feasibility and adherence but require real-world validation.

Purpose of the Study:

• To evaluate the performance of a simplified binary field triage system in identifying severely injured trauma casualties under combat conditions.

Main Methods:

• A cohort study involving military trauma casualties treated by the Israel Defense Forces Medical Corps.
• Field triage designations (urgent vs. nonurgent) were compared with injury severity scores (AIS, ISS) and need for trauma intervention (NFTI).
• Primary outcomes included undertriage and overtriage rates.

Main Results:

• The binary triage system showed an 8.5% undertriage rate for casualties with AIS ≥3 and 3.6% for major trauma (ISS ≥16).
• Sensitivity for detecting severe injury was high (91.5% for AIS ≥3, 96.4% for ISS ≥16).
• Overtriage rates were substantial (62.7% by ISS, 50.2% by NFTI).

Conclusions:

• A simplified, judgment-based binary field triage system demonstrates high sensitivity and low undertriage for major trauma in combat.
• The system's significant overtriage necessitates improvements in detecting less apparent injuries without sacrificing simplicity.
• Findings support the use of simplified triage approaches in operational constraints.