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February 1995

Do Prehospital Trauma Center Triage Criteria Identify Major Trauma Victims?

Author Affiliations

From the Department of Surgery and Shock Trauma Institute, Loyola University, Maywood, Ill (Dr Esposito); Department of Surgery and Injury Prevention and Research Center, Harborview Medical Center, Seattle, Wash (Drs Offner, Jurkovich, and Maier); and the Washington State Department of Health, Olympia (Ms Griffith).

Arch Surg. 1995;130(2):171-176. doi:10.1001/archsurg.1995.01430020061010

Objective:  To evaluate anatomic, physiologic, and mechanism-of-injury prehospital triage criteria as well as the subjective criterion of provider "gut feeling."

Design:  Prospective analysis.

Setting:  A state without a trauma system or official trauma center designation.

Patients:  Patients treated by emergency medical services personnel statewide over a 1-year period who were injured and met at least one prehospital triage criterion for treatment at a trauma center.

Main Outcome Measures:  Outcome was analyzed for injury severity using the Injury Severity Score and mortality rates. A major trauma victim (MTV) was defined as a patient having an Injury Severity Score of 16 or greater. The yield of MTV and mortality associated with each criterion was determined.

Results:  Of 5028 patients entered into the study, 3006 exhibited a singular entry criterion. Triage criteria tended to stratify into high-, intermediate-, and low-yield groups for MTV identification. Physiologic criteria were high yield and anatomic criteria were intermediate yield. Provider gut feeling alone was a low-yield criterion but served to enhance the yield of mechanism of injury criteria when the two criteria were applied in the same patient.

Conclusions:  A limited set of high-yield prehospital criteria are acceptable indicators of MTV. Isolated low- and intermediate-yield criteria may not be useful for initiating trauma center triage or full activation of hospital trauma teams.(Arch Surg. 1995;130:171-176)