|The Red Cross Wound Classification (ICRC, 1997, 16 p.)|
When it is not known which is entry and which is exit a "?" is put between the E and X scores.
When the wounds are multiple only the two most serious are scored.
When a wound cannot be scored "U/C" (unclassifiable) is written on the score. This applies to a minority of wounds.
When one missile causes two wounds e.g. through the arm and into the chest, the 2 separate scores are joined by a bracket.
It is not necessary to score all six points; it is usually possible to give E, F and V scores.
Estimating the presence of a cavity by the width of two fingers is inelegant but simple and effective; it represents slightly more than the length of most bullets. In a wound that admits two fingers, something other than laceration by a bullet travelling sidelong must have taken place; a C1 wound is likely to have significant tissue damage of whatever cause. This should not be confused with the phenomenon of temporary cavitation.
With regard to the F score, it is inevitable that some wounds fall between F1 and F2, but for simplicity this is not accurately defined. An example of clinically insignificant comminution (F1) is a wound with a comminuted fibula but with an intact tibia.
Figure 3a. Gunshot wound of the leg (radiograph); F 1 fracture of the tibia.
Figure 3b. Gunshot wound of the leg (radiograph); F 2 fracture of the tibia.
Figure 3c. Gunshot wound of the leg (radiograph); F 1 fracture (insignificant comminution) of the fibula.
A V1 score implies a more dangerous wound, a surgical task in addition to solely wound management e.g. chest drainage or laparotomy and a requirement for primary closure. V1 includes popliteal and brachial vessels but not the vessels more distal.
It is important that the difference between an intact bullet (M1) and a fragmented bullet (M2) is recognised because of the relationship between bullet fragmentation and wound severity.
The scoring system is still valid without radiography; in this case the F score is judged clinically and the M score is omitted.
Once scored, the wound can be graded according to severity using the E, X, C and F scores, and typed according to structure by the F and V scores.