Trauma care within the military is typically described based on levels defined as follows: Level I, point of injury/first responder care within the combat zone; Level II, resuscitation and surgical stabilization at medical units (not hospitals) within the combat zone (which may be augmented with surgical assets); Level III, medical/surgical care at combat support or other theater hospitals (highest available care in the combat zone); Level IV, regional medical center care located in communication zone (e.g., LRMC), and Level V, definitive treatment/rehabilitation at major tertiary care medical centers in United States.
Injury parameters include type of injury (blunt or penetrating), mechanism of injury, anatomic site, early interventions, and delayed care management. Severity scoring systems are used to provide internal and external comparability of this traumatized patient population both for initial assessment of the traumatic injury and subsequent interval health assessments. The Injury Severity Score (ISS) uses anatomic classification for injury classification and severity scoring.15 Interval assessments of general health are undertaken using the Sequential Organ Failure Assessment (SOFA).16 (link) The SOFA score is composed of scores from six organ systems, graded from 0 to 4 according to the degree of dysfunction/failure.
Infectious disease events are classified using a combination of clinical findings, laboratory and other test results, as shown in Table 1, available through medical record review, applying standardized definitions for nosocomial infections used by the National Healthcare Safety Network (NHSN).17 In addition, a physician’s clinical diagnosis in the absence of meeting a priori defined criteria was also counted as an ID event provided there was initiation of directed antimicrobial therapy with continuation of this therapy for ≥ 5 days. An ID event is excluded if the medical record states an alternative diagnosis is determined accompanied by discontinuation of directed antimicrobial therapy.