Emergency Department

Most trauma centers are aware of the multiple levels of trauma activation. The most common trauma activation scenario is a two tier system, where the higher tier is typically based on physiologic criteria such as hypotension, tachypnea, or decreased mental status. The second tier is used for patients who are usually less seriously injured and calls into play a smaller response team. These patients may actually be discharged from the emergency room after their evaluation. The criteria for the second tier response may include ejection, pedestrian struck, intrusion into passenger compartment of vehicle, death at the scene and others.

A recent retrospective study by the Baylor University Medical Center in Dallas analyzed their data over one and one-half years. (Edmundson, 2017). Their data showed that while mechanism based criteria used for level two trauma activations appear to be less reliable in identifying patients who need partial trauma activation, as 56% had ISS (injury severity score) <5 and 37% were discharged home from the ED. In this study second tier activations for physician discretion had an ISS of 10 and only 13% discharged home from the ED.

When looking at the specific criteria; compartment intrusion of the vehicle, ejection from the vehicle and death in the same vehicle compartment were the major causes of overtriage, or unintentionally overestimating the urgency of the injuries.

Overall, if your hospital sets trauma triage criteria, this study may indicate a need to evaluate your criteria. If your trauma criteria are set regionally or at the state level, it may be time to spur action to re-examine the efficacy of the second tier of trauma response at those levels.

Susan Schmunk, CAISS, CSTR


Edmundson, P. e. (2017, October 17). Journal of the American College of Surgeons. Retrieved October 31, 2017, from The Trauma Pro: http://thetraumapro.com/2017/10/17/acs-trauma-abstracts-3-using-mechanism-criteria-to-activate-the-trauma-team/