Concordance between point of injury reports and findings on arrival at a forward surgical element in Afghanistan

Timothy P Plackett, DO¹, Jamison S Nielsen, DO, MBA², Christina D Hahn, MD³, Jay Rames, MD⁴. ¹Loyola University Medical Center, ²Oregon Health Sciences University, ³Landstuhl Regional Medical Center, ⁴Brooke Army Medical Center

Background: Accurate point of injury reports and casualty evacuation requests allow for optimal resource utilization.  This is particularly important when resources are limited and need to be prioritized.  However, providers often express a frustration with the accuracy of these reports.  This study seeks to quantify the accuracy of these reports.

Methods: All trauma patients treated at one of three forward surgical elements (FSE) in Western Afghanistan during May-August 2012 were prospectively included.  Casualty evaluations reports and initial findings on patient arrival to the FSE were recorded and compared.

Results:  There were 179 events resulting in 268 patients (1.5 patients per event).  Casualty evacuation reports from the point of injury were only available for 187 patients (70%).  The number of patients reported as being evacuated to the FSE was accurate in 94.9% of reports, over-estimated in 4.6% of reports, and under-estimated in 0.6% of reports.  The mechanism of injury was accurate in 98.1% of reports.  Patients were accurately triaged in 76.7% of reports, over-triaged in 17.0%, and under-triaged in 6.3%.  Vital signs were not reported in the majority of patients (73%) prior to arrival at the FSE.  The casualty evacuation report listed a pulse for 46 patients, a blood pressure for 41, and a respiratory rate for 27.  The pre-FSE and initial recorded pulse differed by a mean of 14.3 ± 16.3 beats per minute, the mean arterial pressure differed by a mean of 13.6 ± 10.2 mmHg, and the respiratory rate differed by a mean of 5.5 ± 5.7 breaths per minute.

Discussion: Casualty evacuation reports in the combat environment provide appropriate triage for nearly three-quarters of patients.  However, there is significant room for improvement as over- and under-triage rates are higher than generally accepted civilian standards.  Additional, potentially critical information about the patient’s physiologic status is frequently not being relayed to the FSE.