Afghan war wounded: application of the Red Cross wound classification.

OBJECTIVE: This study was designed to illustrate the application of the Red Cross classification system as a guide to treatment and to demonstrate its ease of use, especially in situations where the treating surgeons may have little experience with or knowledge of ballistic details. DESIGN: The wounds of 123 victims of fighting in Afghanistan are described and categorized according to the Red Cross classification system. MATERIALS AND METHODS: Recent factional fighting in Afghanistan resulted in 123 casualties being admitted to an International Committee of the Red Cross (ICRC) hospital in Quetta, Pakistan, close to the Afghan border. These casualties suffered more than 1300 wounds in total; the two most severe wounds in each casualty were categorized according to the Red Cross classification, described here. This wound classification is quick and easy to apply; it focuses the surgeon's attention on the wound, without requiring any familiarity with terminal ballistics. MEASUREMENTS AND MAIN RESULTS: The majority of wounds, caused by antipersonnel fragments (68.3% of casualties), affected only the soft tissues. Bullet wounds were fewer (22.8% of casualties), but tended to be more severe, often involving a fracture, vascular damage, or injury to a vital structure. CONCLUSIONS: The Red Cross classification permits identification of wound patterns and provides a data base for review of clinical practice and outcome. It is hoped that further data gathered in this manner from ICRC hospitals and others receiving war wounded will add to the understanding of the clinical practice and problems in war surgery.