High-Accuracy Performance of a Simplified Binary Triage System in Military Trauma
Authors' conclusion
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.
Study context
- Population
- Military trauma casualties treated and evacuated by the Israel Defense Forces Medical Corps during a recent conflict, October 27, 2023, to January 19, 202599% male
- Participants
- 4,522 participants
- Exposure
- Simplified judgment-based binary field triage (urgent vs nonurgent) vs anatomic injury severity (Abbreviated Injury Scale (AIS), Injury Severity Score (ISS)) and need for trauma intervention (NFTI)
- Outcome
- Undertriage and overtriage rates
Main finding
As reported in the abstract
Undertriage and overtriage
- Undertriage (nonurgent despite severe injury), any injury AIS ≥3
- 8.5% (95% CI, 6.81%-10.54%)
- Undertriage, major trauma (ISS ≥16)
- 3.6% (95% CI, 2.25%-5.67%)
- Overtriage (urgent triage without severe injury)
- 62.7% (95% CI, 60.65%-64.77%)
- Undertriage, NFTI definition
- 8.8% (95% CI, 7.33%-10.62%)
- Overtriage, NFTI definition
- 50.2% (95% CI, 48.06%-52.32%)
Observational data: associations, not effects.
Further findings
Sensitivity
- Sensitivity, any injury AIS ≥3
- 91.5% (95% CI, 89.46%-93.19%)
- Sensitivity, major trauma (ISS ≥16)
- 96.4% (95% CI, 94.33%-97.75%)
Injuries in undertriaged patients with major trauma
- Severe head and thoracic injuries most common
Original publication
High-Accuracy Performance of a Simplified Binary Triage System in Military Trauma. JAMA Surg. Published 1 August 2026. doi:10.
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