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close this bookThe Red Cross Wound Classification (ICRC, 1997, 16 p.)
View the document(introduction...)
View the documentFOREWORD
View the documentINTRODUCTION
View the documentSCORING THE WOUNDS IN THE FIELD
View the documentADDITIONAL POINTS ABOUT SCORING WOUNDS
View the documentSUBSEQUENT ANALYSIS
View the documentAPPLICATIONS OF THE CLASSIFICATIONS ARE:

SUBSEQUENT ANALYSIS

GRADING THE WOUND ACCORDING TO AMOUNT OF TISSUE DAMAGE

Wounds can be graded 1, 2 and 3 from the E, X, C and F scores.

GRADE 1. Wounds where E plus X is less than 10 with scores C 0 and F 0 or F 1 (low energy transfer).

GRADE 2. Wounds where E plus X is less than 10 with scores C 1 or F 2 (high energy transfer).

GRADE 3. Wounds where E plus X is 10 or more with scores C 1 or F 2 (massive wounds).

TYPING THE WOUND ACCORDING TO STRUCTURES INJURED

Wounds can be typed ST, F, V and VF from the F and V scores.

TYPE ST.

Wounds with F 0 and V 0 (soft tissue).

TYPE F.

Wounds with F 1 or F 2 and V 0.

TYPE V.

Wounds with F 0 and V 1.

TYPE VF.

Wounds with F 1 or F 2 and V 1.

Grading and typing place any regional wound in one of twelve categories each of comparable clinical significance. The clinical examples shown indicate the grade and type of the wound deduced from the score.

12 CATEGORIES


Grade 1.

Grade 2.

Grade 3.

Type ST

Small, simple wounds

2 ST

3 ST

Type F

1 F

2 F

3 F

Type V

1 V

2 V

3 V

Type VF

1 VF

2 VF

Large wounds threatening life or limb

A wound such as traumatic amputation which cannot be scored easily can be categorised; grade 3, type F below the knee, and: grade 3, type VF above the knee.


Fig 4A


Fig 4B

Gunshot wound of the left arm. The entry is indicated by the forceps; the large exit is in the for arm. The radiographs (figure 4b) show the extent of the fracture of the radius and ulna.(E 1, X 12, C 1, F 2, V 0, M 0; Grade 3, Type F).


Fig 5A


Fig 5B

Fragment injury of the head. The brain is exposed. The radiographs (figure 5b) show that there is significant bone loss and the metal fragment has reached the occiput. (E 4, X 0, C -, F 2, V 1, M 1; Grade 2, Type VF).


Fig 6A


Fig 6B

Missile wound of the abdominal wall. Small bowel is extruded from the larger wound. Figure 6b shows the surgeon assessing the wound cavity. Although the peritoneum was breached, the viscera were intact. (E 1, ? X 5, C 1, F 0, V 1, M 0; Grade 2, Type V).


Fig 7A


Fig 7B

Missile injury of a child's left arm. The radiographs (figure 7b) show comminution of the distal humerus. The brachial vessels were not involved. (E 15, X -, C -, F 2, V 0, M 0; Grade 3, Type F).


Fig 8A


Fig 8B

Gushot wound of the left leg. The entry is the small wound on the lateral side of the leg. There are at least two exit wounds because the bullet fragmented in impact (the metal fragments and the fractured fibula can be seen on the radiographs - figure 8b). The foot is ischaemic. (E 1, X 6, C 1, F 1, V 0, M 2; Grade 2, Type F).


Fig 9

Radiograph of a thigh injured by a bullet which has fragmented. The extent of comminution of the distal half of the femur and the metallic fragments are evident (F2 M2). Review of radiographs indicate the incidence of such wounds.

The Red Cross classification permits consideration of wounds as surgical lesions rather than weaponry phenomena; it refines the heterogeneity of wounds according to their clinical significance.

The limitations of the scoring are recognised; complete accuracy cannot be obtained. It should be emphasised that the scoring is for rapid use under adverse conditions and uses no additional equipment. The advantages of using the classification outweigh any disadvantage that may be introduced by observer error in occasional patients.