High-Accuracy Performance of a Simplified Binary Triage System in Military Trauma.
Simplified binary field triage missed only 3.6% of major trauma casualties in combat.
High-Accuracy Performance of a Simplified Binary Triage System in Military Trauma.
IMPORTANCE: Accurate prehospital triage is critical for prioritizing evacuation and allocating medical resources in combat settings characterized by diagnostic uncertainty and operational constraints.
To evaluate the performance of a simplified binary field triage system in identifying severely injured trauma casualties under real-world combat conditions.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted between October 27, 2023, and January 19, 2025.
Among 4522 casualties (median [IQR] age, 23 [20-29] years; 4479 male [99%]), a judgment-based binary approach was associated with an undertriage rate, classification as nonurgent despite severe injury, of 8.5% (95% CI, 6.81%-10.54%) among casualties with any injury with an Abbreviated Injury Scale score of 3 or greater.
Corresponding sensitivities were 91.5% (95% CI, 89.46%-93.19%) and 96.4% (95% CI, 94.33%-97.75%), respectively.
Using the NFTI definition, undertriage was 8.8% (95% CI, 7.33%-10.62%), and overtriage was 50.2% (95% CI, 48.06%-52.32%).
In undertriaged patients with major trauma, severe head and thoracic injuries were most common.
In this cohort study, a simplified, judgment-based binary field triage system demonstrated high sensitivity with low undertriage for major trauma in combat settings, at the cost of substantial overtriage.
These findings support the use of simple triage approaches under operational constraints while highlighting the need to improve detection of less apparent injuries without compromising simplicity.