Trauma Team Consultation and ED Admission

Original Date: 10/2019 | Supersedes: 06/2021 | Last Review Date: 04/2022
Purpose: To provide consistent guidance for indications for trauma team consultation.

Urgent Trauma Consult Criteria – trauma resident evaluation within 30 minutes and faculty evaluation within 2 hours

Trauma service notification:  consult notification of faculty and residents via Perfect Serve app

Trauma residents:  please document time of consultation and time of arrival in H&P, notify faculty immediately after evaluating patient, and identify urgent trauma consults during morning report

Trauma faculty:  please sign the Supervising Attending Admission MPP in Care4

Any traumatic mechanism of injury not meeting a level one activation criteria and during initial evaluation are found to have any of the following:

  1. Positive FAST exam
  2. Hemothorax or pneumothorax seen on screening CXR
  3. Flail chest
  4. Any suspected vascular injury (asymmetric pulse or ABI < 0.9)
  5. Two or more long bone fractures (includes humerus, femur, and tib-fib). Please activate urgent trauma page before definitive splinting by orthopedic surgery
  6. ANY suspected spinal cord injury (hemiparesis, sensory level, central cord, etc)

Standard Consult Criteria

Trauma service notification:  consult notification of residents via Perfect Serve app

Patients with traumatic mechanism of injury not meeting any level one activation or urgent consult criteria who are found to have any of the following should receive a trauma consult:

  1. Persistent base deficit ≥ 4 (persistent = not easily correctable with 1L or less of Isolyte)
  2. Head injury with abnormal CT scan or need for observation in a monitored bed (COU, ICU, IMU) unless isolated TBI in non-intubated patient. These patients can be admitted to Neurosurgery without consulting trauma.
  3. Complex facial fractures (mandible, LeFort 2/3 fractures)
  4. Any intra-abdominal injury
  5. Persistent abdominal pain requiring hospitalization for serial examinations
  6. Acetabular or pelvic ring fracture in anti-coagulated patient (excluding ASA/Plavix)
  7. Hemothorax/pneumothorax seen on CT
  8. Multiple rib fractures (≥ 2) in patient requiring hospitalization
  9. Suspected or confirmed urethral or bladder injury
  10. Blunt carotid or vertebral artery injury

If mechanism of injury is greater than ground level fall:

  1. Pelvic fracture identified on CT
  2. Cervical spine fracture (excluding isolated SP fractures)
    1. Isolated cervical spine fracture without any other injury or other criteria on the above lists does not need to be evaluated by the trauma service
  3. Thoracic or lumbar spine fracture (excluding isolated SP/TP fractures)
    1. Isolated thoracic or lumbar spine fracture without any other injury or other criteria on the above lists does not need to be evaluated by the trauma service

Trauma Service Admission Criteria from ED

Patients meeting criteria for urgent and standard trauma consultation should be admitted to the trauma service.

Please see exceptions listed below.

Geriatric Trauma Service (GTS) Admission Criteria from ED*

Patients ≥ 65 years old may be admitted to the GTS after evaluation by trauma faculty.

GTS will NOT admit the following patients:

  • ICU level of care
  • Traumatic Brain Injury on CT scan
  • any emergent procedure (IR or OR) from ED
  • patients that received blood transfusion

Hospitalist Service Admission Criteria from ED*

Patients < 65 years old with isolated orthopedic injuries AND medical comorbidities may be admitted to the hospitalist service based on trauma service volume and capacity.

*May consider transfer to GTS/hospitalist after completed tertiary and hemodynamic stability based on service capacity and projected length of stay.  Transfer is best facilitated by faculty to faculty conversation.