|
Overview :
The American
College of Surgeons Committee on Trauma published guidelines in 1980 for the
field categorization of trauma patients. These are intended to help in the
prehospital triaging of patients with transportation to the appropriate
facility.
|
Severity of
Injury |
Category |
|
severe |
I |
|
moderate |
II |
|
less
severe |
III |
|
System |
Injury |
Category |
|
soft
tissue |
avulsion
type injuries |
1 |
|
|
severe,
uncontrolled bleeding |
1 |
|
|
soft
tissue injuries with stabilized bleeding |
2 |
|
|
soft
tissue injuries of moderate degree |
3 |
|
fractures |
multiple
open fractures |
1 |
|
|
pelvic
fractures |
1 |
|
|
single
open fracture |
2 |
|
|
closed
fractures |
2 |
|
|
uncomplicated
fractures |
3 |
|
abdomen |
blunt or
penetrating abdominal injuries associated with
hypotension |
1 |
|
|
blunt
abdominal or penetrating trauma not producing
hypotension |
2 |
|
|
no
abdominal injuries |
3 |
|
chest |
unstable
chest injuries |
1 |
|
|
respiratory rate > 30 or < 10
per minute |
1 |
|
|
multiple
rib fractures without flail segments |
2 |
|
|
respiratory rate > 20 or <=
30 |
2 |
|
|
no
respiratory distress, respiratory rate 10-20 |
3 |
|
head and
neck, upper respiratory |
severe
maxillofacial injuries |
1 |
|
|
open
penetrating and blunt trauma to face, neck and cervical
spine |
1 |
|
|
multiple
facial fractures |
1 |
|
|
injuries
affecting vision |
1 |
|
|
facial
trauma with single facial fracture without airway or major cervical
vascular or cervical spine involvement |
2 |
|
|
simple
contusions of head and neck |
3 |
|
|
nasal
fractures |
3 |
|
neurological |
prolonged
loss of consciousness |
1 |
|
|
posturing |
1 |
|
|
lateralizing
signs |
1 |
|
|
open
cranial injuries |
1 |
|
|
paralysis |
1 |
|
|
transient
loss of consciousness, but now oriented to time, place and
person |
2 |
|
|
no
neurological injuries |
3 |
|
vital
signs |
blood
pressure < 90 mm Hg; pulse > 100 or < 60; skin cool, ashen
pale |
1 |
|
|
blood
pressure 90-100 mm Hg systolic; pulse 60-100; skin warm to slightly
cool |
2 |
|
|
blood
pressure > 100 mm Hg systolic; pulse 60-100; skin dry and
warm |
3 |
where:
• severe maxillofacial injuries listed as
category 1 for both fractures and head-neck; included only with head and
neck
• I found the wording for fracture
category 2 a little ambiguous ("single open or closed
fractures")
• respiratory rate for category 2 was
"> 20 and < 10", while for category 1 it was "> 30 and < 10"; opted
to make category 2 "> 20 and <= 30"
Interpretation:
• Patients with Category I injuries
should be treated at Level I or II facilities.
• Patients with Category III injuries
should be treated at a Level III facility.
• Resources for region may dictate
triaging of the patient if adequate trauma centers are not
available.
| References: | |
American College of Surgeons Committee on
Trauma. Field categorization of trauma patients and hospital trauma index.
Bulletin of the American College of Surgeons. 1980 (February): 65:
28-33.
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