Trauma Team Consultation

Original Date: 07/2025

Urgent Trauma Consult Criteria – APP or Surgeon evaluation within 60 minutes

  • Notification – ED physician/APP notifies Trauma surgeon/APP by Rover and enters consult order into EPIC
  • Documentation – H+P/Consult note should document time at which the patient was evaluated
  • Criteria – any traumatic mechanism of injury not meeting Level 1 activation criteria and found to have the following during initial evaluation:
    • Positive FAST exam
    • Hemothorax or pneumothorax seen on screening CXR
    • Any suspected vascular injury (asymmetric pulse or ABI <0.9)
    • Bilateral femur fractures
    • Any suspected spinal cord injury (hemiparesis, central cord, etc…; not peripheral nerve injury)

Standard Consult Criteria

  • Notification – ED physician/APP notifies Trauma surgeon by Rover and enters consult order into EPIC
  • Criteria – any traumatic mechanism not meeting Level 1 activation criteria or urgent consult criteria who are found to have any of the following:
    • Persistent base deficit ≥4 (persistent = not easily correctable with 1L or less of crystalloid)
    • Traumatic brain injury (tiered according to Brain Injury Guideline [BIG] score):
      • BIG 1 if ED physician believes patient needs placement in observation longer than 6 hours
      • All BIG 2 and BIG 3 patients
    • Any intra-abdominal injury
    • Persistent abdominal pain requiring hospitalization for serial examinations
    • Hemothorax or pneumothorax seen on CT
    • Multiple rib fractures (≥2) in a patient requiring hospitalization
    • Suspected or confirmed uretheral, bladder, ureter, or kidney injury
    • Blunt carotid or vertebral artery injury (BCVI)
    • Any cervical, thoracic, or lumbar spine fractures with a mechanism of injury greater than ground level fall (excluding transverse process fractures)
    • Any patient with injuries in more than one system.
    • Patients with injuries for which they are to be transferred out

Trauma Service Admission Criteria from ED

  • Patients meeting criteria for urgent and standard trauma consultation should be admitted to the trauma service.
  • Exceptions:
    • Patients ≥65 years old with isolated extremity fracture may be admitted to the Hospitalist service with an orthopedic consult
    • Patients <65 years old with an isolated orthopedic injury AND medical comorbidities may be admitted to the Hospitalist service with an orthopedic consult
    • If a trauma patient has a concomitant medical emergency (e.g. acute coronary syndrome, stroke, COPD exacerbation) for which care by a medical provider supersedes the need for trauma care, the patient may be admitted to a medical provider with a trauma service consultation.
  • After 24 hours, a patient may be transferred from the trauma to the hospitalist service if agreed to by both services.
  • All patients admitted to the SICU will be admitted to the trauma service. The hospitalist may consult if requested.
  • Adult trauma patients are aged 16 years and older.