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Thomas J. Esposito, MD, MPH; Patrick J. Offner, MD, MPH; Gregory J. Jurkovich, MD; Janet Griffith, MA; Ronald V. Maier, MD

Arch Surg. 1995;130(2):171-176.

Abstract
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)

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).

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