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John A. Morris, Jr, MD; Paul S. Auerbach, MD; Gregory A. Marshall; Raymond F. Bluth; Lynda G. Johnson, PhD; Donald D. Trunkey, MD

JAMA. 1986;256(10):1319-1325.

Abstract
Implementation of a regional trauma care system requires a field triage tool that identifies the severely injured patient and transports him to a trauma center, while preserving the flow of minimally injured patients to community hospitals. We prospectively tested the Trauma Score (TS) as a field triage tool and evaluated its accuracy against that of the Injury Severity Score (ISS), calculated after the patients' injuries were fully defined. During an 18-month period, 1106 patients admitted to the trauma center at San Francisco General Hospital had a TS determined in the field (TS₁) and on arrival at the emergency department. A TS₁ of 14 or less defined a subgroup of 222 patients in whom 93% of the deaths occurred. Using an ISS of 20 or more as an indicator of life-threatening injury, we determined the predictive value of TS₁. There were 66 false-negatives (ISS, 20; TS₁, 15 or 16) and 107 false-positives (ISS, <20; TS₁, 14). Using a prehospital TS of 14 or less as an indicator of serious injury, only 20% of a major urban trauma population would qualify for diversion to a trauma center.

(JAMA 1986;256:1319-1325)

Author Affiliations
From the Department of Surgery, San Francisco General Hospital Drs Morris, Auerbach, and Johnson are now with the Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tenn. Dr Trunkey is now with the Department of Surgery, University of Oregon, Portland. Mr Marshall is now at the University of Southern California School of Medicine, Los Angeles. Mr Bluth is now at the Vanderbilt University School of Medicine.

Footnotes
Reprint requests to Department of Surgery, Vanderbilt University School ot Medicine, Nashville, TN 37232 (Dr Morris).

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