Why to Use
The Bastion Classification was developed as a classification system to comprehensively describe the injury pattern of lower extremities after blast injuries. It correlates with treatment need, such as the requirement for operative proximal vascular control or amputation level. The criteria are helpful for facilitating communication between clinicians and for operative management.
When to Use
Management depends on the injuries diagnosed. Using the Bastion Classification and its suffixes, emergency department physicians and trauma surgeons can anticipate the need for other surgical consultations and the resources required for treatment.
Jennie Kim, MD
Travis Polk, MD
A panel of military surgeons, Jacobs et al, developed the Bastion Classification and performed a prospective validation study with 103 patients who sustained 179 lower limb injuries caused by improvised explosive devices treated at Camp Bastion, Afghanistan, from November 2010 to February 2011.
The primary aim of the proposed classification was to provide a pragmatic, comprehensive, and clinically relevant system to better facilitate the transfer of information. Currently existing lower limb injury classification systems fail to describe the complete injury pattern or correlate with management. The Internal Committee of the Red Cross classification is broad and does not provide information on the severity of injury. The Mangled Extremity Severity Score (MESS), Gustilo and Anderson, and Müller AO classifications do not provide information on injury level. The Müller AO classification also does not take into account soft tissue injury. The secondary aim of the study by Jacobs et al was to facilitate the assessment of interventions. The Bastion Classification did show a predictable association with the level of initial musculoskeletal debridement and/or amputation and the level of vascular control.
The original study was not designed to correlate class of injury with outcomes such as mortality, transfusion requirements, or definitive amputation level, and thus, this information is not provided in the publication nor in the conclusions made.
A study in 2013 by Lundy and Hobbs looked at 67 patients with 117 injured limbs caused by dismounted blast exposure. The authors noted that the Bastion Classification appeared to be predictive of initial musculoskeletal treatment but was less useful in predicting the need for proximal vascular control, especially in the most common Class 3 injuries. The original study by Jacobs et al showed that Class 3 injuries correlated with a higher rate of intra- or extraperitoneal iliac vessel control (23% of 83 Class 3 injured limbs without associated abdominal injuries) compared to the study by Lundy et al that only had 1 patient with a Class 3 injury without associated abdominal injury and 6 (5%) of all injured limbs requiring iliac vessel control. The 2013 study does not comment on correlation of the Bastion Classification to mortality rates.
Neal Jacobs, MD
Copyright © MDCalc • Reprinted with permission.
Caylyne Arnold, DO; Zane Fayos, MD; David Bruner, MD, FAAEM; Dylan Arnold, DO
December 1, 2017
December 31, 2020