Gulf war wounds: application of the Red Cross wound classification

The Red Cross wound classification was applied to 63 casualties requiring surgery in the recent Gulf war. The majority of wounds affect only soft tissue, caused predominantly by antipersonnel fragments. Bullet wounds were fewer but tended to be more severe, often involving a fracture or vascular damage. We recommend minor modification to the classification to include scoring of significant neurological injury. Further, we feel that by recording the distribution of all wounds as well as scoring the casualty's two worst injuries, the incidence and pattern of multiple wounds are ascertained, which is useful in military surgical research. We believe that the Red Cross wound classification is valuable in assessing a wound as part of a secondary survey, but that this wound score has little part to play in triage. It may help to decide management of individual wounds in clinical practice and is useful for recording the nature of wounds for future analysis.