Field Triage Research Articles

Association of Prehospital Step 1 Vital Sign Criteria and Vital Sign Decline with Increased Emergency Department and Hospital Death

This study analyzed data from the 2017 American College of Surgeons National Trauma Data Bank to examine the effects of pre-hospital Field Triage Decision Scheme Step 1 vital sign criteria (S1C) and vital sign decline on subsequent emergency department (ED) and hospital death in emergency medical services (EMS) transported trauma victims. Patient and injury characteristics, transport time, and ED and hospital disposition were collected. S1C (respiratory rate [RR]<10, RR>29 breaths/min, systolic blood pressure [SBP]<90 mmHg, Glasgow Coma Scale [GCS]<14) were recorded at the injury scene and hospital arrival. Decline was defined as a change ≥ 1 standard deviation (SD) into or within an S1C range. S1C and decline were analyzed relative to ED and hospital death using logistic regression. Of 333,213 included patients, 54,849 (16.5%) met Step 1 criteria at the scene, and 21,566(6.9%) declined en route. The ED death rate was 0.4% (n= 1,188), and the hospital death/hospice rate was 4.0% (11,624 of 287,675). Patients who met S1C at the scene or who declined were more likely to require longer hospital lengths of stay, ICU admission, and surgical intervention. S1C and decline patients had higher odds of death in both the ED (S1C odds ratio [OR] 15.1, decline OR 2.4, p values < 0.001) and hospital (S1C OR 4.8, decline OR 2.0, p values < 0.001) after adjusting for patient demographics, transport time and mode, injury severity, and injury mechanism. Each S1C and decline measure was independently predictive of death. This study quantifies the mortality risks associated with individual S1C and validates their use as an indicator for injury severity and pre-hospital triage tool.

Out with the Old and in With the New: Deimplementation in Emergency Medicine.

Much of emergency medicine care and quality standards are rooted in evidence-based guidelines. The Society for Academic Emergency Medicine (SAEM) and the journal Academic Emergency Medicine through publications, conferences, and various initiatives have encouraged the emergency medicine community to create and disseminate evidence-based guidelines. New and updated guidelines must also be implemented into practice. Increasing numbers of publications in this journal and elsewhere are shining light on how the theories and frameworks of implementation science can increase the uptake, reach, and sustainability of evidence-based guidelines in emergency medicine.

Comparing geographic information system-based estimates with trauma center registry data to assess the effects of additional trauma centers on system access.

Geographic information systems (GISs) are often used to analyze trauma systems. Geographic information system-based approaches can model access to a trauma center (TC), including estimates of transport time and population coverage, when accurate trauma registry and emergency medical systems (EMS) data are not available. We hypothesized that estimates of trauma system performance calculated using a standard GIS method with public data would be comparable with trauma registry data. A standardized GIS-based method was used to estimate metrics of TC access in a regional trauma system in which the number of TCs increased from one to three during a 3-year period. Registry data from the index TC in the system were evaluated for different periods during this evolution. The number of admissions to the TC in different periods was compared with changes predicted by the GIS-based model, and the distribution of observed ground-based transportation times was compared with the predicted distribution. With the addition of two TCs to the system, the volume of patients transported by ground to the index TC decreased by 30%. However, the model predicted a 68% decrease in population having the shortest predicted transport time to the index TC. The model predicted the geographic trend seen in the registry data, but many patients were transported to the index TC even though it was not the closest center. Observed transport times were uniformly shorter than predicted times. The GIS-based model qualitatively predicted changes in distribution of trauma patients, but registry data highlight that field triage decisions are more complex than model assumptions. Similarly, transport times were systematically overestimated. This suggests that model assumptions, such as vehicle speed, based on normal traffic may not fully reflect emergency medical systems (EMS) operations. There remains great need for metrics to guide policy based on widely available data. Epidemiological, level III.

Right Patient, Right Place, Right Time : Field Triage and Transfer to Level I Trauma Centers.

This study sought to compare outcomes of trauma patients taken directly from the field to a Level I trauma center (direct) versus patients that were first brought to a Level III trauma center prior to being transferred to a Level I (transfer) within our inclusive Delaware trauma system. A retrospective review of the Level I center's trauma registry was performed using data from 2013 to 2017 for patients brought to a single Level I trauma center from 2 surrounding counties. The direct cohort consisted of 362 patients, while the transfer cohort contained 204 patients. Linear regression analysis was performed to investigate hospital length of stay (LOS), while logistic regression was used for mortality, complications, and craniotomy. Covariates included age, gender, county, and injury severity score (ISS). Propensity score weighting was also performed between the direct and transfer cohorts. When adjusting for age, gender, ISS, and county, transferred patients demonstrated worse outcomes compared with direct patients in both the regression and propensity score analyses. Transferred patients were at increased risk of mortality (odds ratio [OR] 2.17, CI 1.10-4.37, P = .027) and craniotomy (OR 3.92, CI 1.87-8.72, P < .001). Age was predictive of mortality (P < .001). ISS was predictive of increased risk of mortality (P < .001), increased LOS (P < .001), and craniotomy (P < .001). Older age, Sussex County, and higher ISS were predictive of patients being transferred (P < .001). Delays in the presentation to our Level I trauma center resulted in worse outcomes. Patients that meet criteria should be considered for transport directly to the highest level trauma center in the system to avoid delays in care.

Disaster Response to a Mass Casualty Incident in a Hospital Fire by Regional Disaster Medical Assistance Team: Characteristics of Hospital Fire.

A disaster in the hospital is particularly serious and quite different from other ordinary disasters. This study aimed at analyzing the activity outcomes of a disaster medical assistance team (DMAT) for a fire disaster at the hospital. The data which was documented by a DMAT and emergent medical technicians of a fire department contained information about the patient's characteristics, medical records, triage results, and the hospital which the patient was transferred from. Patients were categorized into four groups according to results of field triage using the simple triage and rapid treatment method. DMAT arrived on the scene in 37 minutes. One hundred and thirty eight (138) patients were evacuated from the disaster scene. There were 25 patients (18.1%) in the Red group, 96 patients (69.6%) in the Yellow group, and 1 patient (0.7%) in the Green group. One patient died. There were 16 (11.6%) medical staff and hospital employees. The injury of the caregiver or the medical staff was more severe compared to the family protector. For an effective disaster-response system in hospital disasters, it is important to secure the safety of medical staff, to utilize available medical resources, to secure patients' medical records, and to reorganize the DMAT dispatch system.

The “Golden Hour” and field triage pattern for road trauma patients

Introduction: Although the term “golden hour” is a well-known concept among trauma system and emergency medical service providers, the relationship between time and trauma patient outcome and the process of prehospital care for road trauma patients in rural settings are poorly understood. As the underlying basis for triage decision-making, the estimated transport interval to trauma center is usually absent in the existing studies. Method: In this study, the crash data between 2013 and 2017 were obtained from the Fatality Analysis Reporting System, and the estimated intervals were calculated by using a Geographic Information System software. By comparing the estimated intervals with actual emergency medical services records, the field triage patterns for road patients were investigated at the state and county levels. Results and Conclusions: With the help of the interval prediction maps, the different triage patterns among counties were identified. Further, the average fatalities per 100,000 population by county from the National Highway Traffic Safety Administration were adopted to clarify the associated outcomes. The linear regression analysis results revealed that, for most states, all intervals except the notification interval had a significant correlation with the mortality. The estimated interval had a more significant relationship with the mortality than the actual transport interval. Practical applications: These findings indicated that adhering to the “golden hour” without regarding the destination may not be helpful for the survival of road trauma patients. The regression analyses and the interval maps can be used to identify patterns of inappropriate destination selection so that prospective decision-making can be improved.

Flipped Classroom Approach Used in the Training of Mass Casualty Triage for Medical Undergraduate Students.

The aim of this study was to explore the application of the flipped classroom approach in the training of Mass Casualty Triage (MCT) to medical undergraduate students. In this study, 103 fourth-year medical students were randomly divided into a Flipped Classroom (FC) group (n = 51) and a Traditional Lecture-based Classroom (TLC) group (n = 52). A post-class quiz, simulated field triage (SFT) and feedback questionnaires were performed to assess both groups of students for their learning of the course. In the post-quiz, the median (IQR) scores achieved by students from the FC and TLC groups were 42(5) and 39(5.5), respectively. Significant differences were found between the two groups. In the SFT, overall triage accuracy was 67.06% for FC, and 64.23% for TLC students. Over-triage and under-triage errors occurred in 18.43% and 14.50% of the FC group, respectively. The TLC group had a similar pattern of 20.77% over-triage and 15.0% under-triage errors. No significant differences were found regarding overall triage accuracy or triage errors between the two groups. The FC approach could enhance course grades reflected in the post-quiz and improve students' satisfaction with the class. However, there was no significant difference of competency between the two groups demonstrated in the SFT exercise.

Mortality and hospitalisation in the Danish Helicopter Emergency Medical Service (HEMS) population from 2014 to 2018: a national population-based study of HEMS triage

ObjectiveTo describe characteristics and outcomes for patients where the Danish Helicopter Emergency Medical Service (HEMS) either transported the patient to hospital, treated the patient on scene but did not transport...

Association Between Trauma Center Level and Outcomes of Adult Patients with Motorcycle Crash-Related Injuries in the United States.

Motorcycle crash-related injury mechanism is a criterion in the Centers for Disease Control and Prevention field triage guidelines of injured patients, with a recommendation to transport affected patients to a trauma center need not be the highest level. This study examines the evidence behind this recommendation because severe injuries can result from motorcycle crashes and patients can benefit from treatment at higher-level trauma centers. This retrospective cohort study used the National Trauma Data Bank 2015 dataset. We conducted descriptive analyses (univariate and bivariate) followed by adjusted multivariate analysis to examine the association between trauma center designation levels and survival to hospital discharge. A total of 28,821 patients with motorcycle injuries were included. Most patients were men (n=25,361; 88%) and aged between 16 and 64years (n=26,989; 93.6%). Survival rates were higher in level II (n=10,658; 95.3%) and III (n=2,129; 95.5%) trauma centers compared to level I centers (n=14,498; 94.6%). After adjusting for confounders, decreased survival to hospital discharge was noted for patients treated at level III trauma centers compared to those at level I centers (odds ratio 0.543; 95% confidence interval 0.390-0.729). No difference in survival was noted between level I and II centers. Patients with motorcycle crash-related injuries treated at higher-level trauma center (I or II) had increased survival. This warrants a re-evaluation and adjustment of the field triage criterion for such patients. Examining the evidence behind field triage guidelines in trauma systems is needed for improved patient outcomes.

Out-of-hospital Circulatory Measures to Identify Patients With Serious Injury: A Systematic Review.

The objective was to systematically identify and summarize out-of-hospital measures of circulatory compromise as diagnostic predictors of serious injury, focusing on measures usable by emergency medical services to inform field triage decisions. We searched Ovid MEDLINE, CINAHL, and the Cochrane databases from 1996 through August 2017 for published literature on individual circulatory measures in trauma. We reviewed reference lists of included articles for additional relevant citations. Measures of diagnostic accuracy included sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). Indicators of serious injury included resource need, serious anatomic injury, and mortality. We pooled estimates when data permitted. We identified 114 articles, reporting results of 111 studies. Measures included systolic blood pressure (sBP), heart rate (HR), shock index (SI), lactate, base deficit, and HR variability. Pooled out-of-hospital sensitivity estimates were sBP<90mmHg=19% (95% confidence interval [CI]=12% to 29%), HR≥110 beats/min=28% (95% CI=20% to 37%), SI >0.9=37% (95% CI=22% to 56%), and lactate >2.0mmol/L=74% (95% CI=48% to 90%). Pooled specificity estimates were sBP<90mmHg=95% (95% CI=91% to 97%), HR≥110 beats/min=85% (95% CI=74% to 91%), SI>0.9=85% (95% CI=72% to 92%), and lactate >2.0mmol/L=62% (95% CI=51% to 72%). Pooled AUROCs included sBP=0.67 (95% CI=0.58 to 0.75), HR=0.67 (95% CI=0.56 to 0.79), SI=0.72 (95% CI=0.66 to 0.77), and lactate=0.77 (95% CI=0.67 to 0.82). Strength of evidence was low to moderate. Out-of-hospital circulatory measures are associated with poor to fair discrimination for identifying trauma patients with serious injuries. Many seriously injured patients have normal circulatory measures (low sensitivity), but when present, the measures are highly specific for identifying patients with serious injuries.

Out-of-hospital Respiratory Measures to Identify Patients With Serious Injury: A Systematic Review.

The objective was to systematically review the published literature on the diagnostic accuracy of out-of-hospital respiratory measures for identifying patients with serious injury, focusing on measures feasible for field triage by emergency medical services personnel. We searched Ovid MEDLINE, CINAHL, and the Cochrane databases from January 1, 1996, through August 31, 2017. We included studies on the diagnostic accuracy (sensitivity, specificity, and area under the receiver operating characteristic curve [AUROC]) for all respiratory measures used to identify patients with serious injury (resource use, serious anatomic injury, and mortality). We assessed studies for risk of bias and strength of evidence (SOE). We performed meta-analysis for measures with sufficient data. We identified 46 articles reporting results of 44 studies. Out-of-hospital respiratory measures included respiratory rate, pulse oximetry, and airway support. Meta-analysis was only possible for respiratory rate, which demonstrated a pooled sensitivity for serious injury of 13% (95% confidence interval [CI]= 5 to 29, I2 =97.8%), specificity of 96% (95% CI= 83 to 99, I2 =99.6%), and AUROC of 0.70 (95% CI= 0.66 to 0.79, I2 =16.6%). For oxygen saturation, sensitivity ranged from 13% to 63%; specificity, 85% to 99%; and AUROC, 0.53 to 0.76. Need for airway support had a sensitivity of 8% to 53% and specificity of 61% to 100%; studies did not report AUROC. Across respiratory measures, the SOE was low. Other respiratory measures (pH, end-tidal carbon dioxide [CO2 ], and sublingual partial pressure of CO2 ) were reported only in emergency department studies. Data on the accuracy of out-of-hospital respiratory measures for field triage are limited and of low quality. Based on available research, respiratory rate, oxygen saturation, and need for airway intervention all have low sensitivity, high specificity, and poor to fair discrimination for identifying seriously injured patients.

Current trauma care system in Saudi Arabia: A scoping literature review

BackgroundTrauma is one of the leading causes of death worldwide with millions of people dying each year, particularly in low or middle-income countries. This paper describes and evaluates the current trauma system (TS) in Saudi Arabia (SA). MethodsA scoping literature review was performed, incorporating an extensive search of Medline and Embase databases for refereed literature, as well as a search of grey literature to locate unpublished articles or reports in English or Arabic. All publications were assessed against the World Health Organization (WHO) Trauma System Maturity Index (TSMI) and American College of Surgeon’s (ACS) criteria. ResultsDespite local injury prevention efforts, Motor Vehicle Crashes (MVC) remain the primary cause of injuries in SA. Prehospital trauma care in SA aligns with level III care as described in the WHO TSMI classification system, based on the presence of formal emergency medical services and universal access to care. With respect to the ACS classification, no clear written guidelines, either for field triage or trauma destination protocols such as trauma bypass, were identified in prehospital trauma care. The role of secondary and tertiary facilities in treating trauma patients is unclear, with no clear referral linkages, suggesting a level I to III grading of SA’s trauma care facilities. Currently, there is no national or regional electronic trauma registry, no quality assurance program, and active involvement in research projects related to injuries is limited. ConclusionThe current SA TS has strengths but there are key features missing in comparison to other systems globally. As MVCs remain a leading cause of death/ disability, efforts to reduce the prevalence and impact of MVC burden in SA through development of a stronger national TS are warranted.

Disparities in rural versus urban field triage: Risk and mitigating factors for undertriage.

There are well-known disparities for patients injured in rural setting versus urban setting. Many cite access to care; however, the mechanisms are not defined. One potential factor is differences in field triage. Our objective was to evaluate differences in prehospital undertriage (UT) in rural setting versus urban settings. Adult patients in the Pennsylvania Trauma Outcomes Study (PTOS) registry 2000 to 2017 were included. Rural/urban setting was defined by county according to the Pennsylvania Trauma Systems Foundation. Rural/urban classification was performed for patients and centers. Undertriage was defined as patients meeting physiologic or anatomic triage criteria from the National Field Triage Guidelines who were not initially transported to a Level I or Level II trauma center. Logistic regression determined the association between UT and rural/urban setting, adjusting for transport distance and prehospital time. Models were expanded to evaluate the effect of individual triage criteria, trauma center setting, and transport mode on UT. There were 453,112 patients included (26% rural). Undertriage was higher in rural patients (8.6% vs. 3.4%, p < 0.01). Rural setting was associated with UT after adjusting for distance and prehospital time (odds ratio [OR], 3.52; 95% confidence interval [CI], 1.82-6.78; p < 0.01). Different triage criteria were associated with UT in rural/urban settings. Rural setting was associated with UT for patients transferred to an urban center (OR, 3.32; 95% CI, 1.75-6.25; p < 0.01), but not a rural center (OR, 0.68; 95% CI, 0.08-5.53; p = 0.72). Rural setting was associated with UT for ground (OR, 5.01; 95% CI, 2.65-9.46; p < 0.01) but not air transport (OR, 1.18; 95% CI, 0.54-2.55; p = 0.68). Undertriage is more common in rural settings. Specific triage criteria are associated with UT in rural settings. Lack of a rural trauma center requiring transfer to an urban center is a risk factor for UT of rural patients. Air medical transport mitigated the risk of UT in rural patients. Provider and system interventions may help reduce UT in rural settings. Care Management, Level IV.

Field triage of children with abdominal trauma

Objective Identify physical findings in children with abdominal trauma to inform prehospital providers regarding appropriate hospital destinations. Methods This is a secondary analysis of the Pediatric Emergency Care Applied Research Network Abdominal Trauma Public Use Dataset. Children involved in motor vehicle collisions; struck by motor vehicles at &gt;20 mph; involved in all-terrain vehicle, motorcycle, or scooter accidents; or who fell from &gt;10 ft ( n = 5575) were included. Stepwise multivariable multinomial logistic regression was used to compare clinical findings at presentation between children with no intra-abdominal injury, intra-abdominal injury without intervention, and intra-abdominal injury with intervention (laparoscopy/laparotomy, embolization, red blood cell transfusion, or admission &gt;48 h on intravenous fluids). Results Compared to children with no intra-abdominal injury, children with intra-abdominal injury (with and without intervention) were more likely to have evidence of abdominal wall trauma, abdominal tenderness, peritoneal irritation, decreased breath sounds, distracting painful injury, and evidence of thoracic trauma. Children with intra-abdominal injury requiring intervention were more likely to have evidence of abdominal wall trauma (OR 3.32, 95% CI 2.03–5.44) and be intubated (OR 4.93, 95% CI 3.17–7.65) when compared to children with intra-abdominal injury without intervention. Conclusions The findings of abdominal tenderness, peritoneal irritation, decreased breath sounds, distracting painful injury, and thoracic trauma may be used to identify children who warrant evaluation at any trauma center because of increased risk of intra-abdominal injury, whereas intubation and evidence of abdominal wall trauma help identify children with intra-abdominal injury in need of transport to a pediatric trauma center due to risk of undergoing intervention.

The impact of the Trauma Triage App on pre-hospital trauma triage: design and protocol of the stepped-wedge, cluster-randomized TESLA trial

BackgroundField triage of trauma patients is crucial to get the right patient to the right hospital within a particular time frame. Minimization of undertriage, overtriage, and interhospital transfer rates could substantially reduce mortality rates, life-long disabilities, and costs. Identification of patients in need of specialized trauma care is predominantly based on the judgment of Emergency Medical Services professionals and a pre-hospital triage protocol. The Trauma Triage App is a smartphone application that includes a prediction model to aid Emergency Medical Services professionals in the identification of patients in need of specialized trauma care. The aim of this trial is to assess the impact of this new digital approach to field triage on the primary endpoint undertriage.MethodsThe Trauma triage using Supervised Learning Algorithms (TESLA) trial is a stepped-wedge cluster-randomized controlled trial with eight clusters defined as Emergency Medical Services regions. These clusters are an integral part of five inclusive trauma regions. Injured patients, evaluated on-scene by an Emergency Medical Services professional, suspected of moderate to severe injuries, will be assessed for eligibility. This unidirectional crossover trial will start with a baseline period in which the default pre-hospital triage protocol is used, after which all clusters gradually implement the Trauma Triage App as an add-on to the existing triage protocol. The primary endpoint is undertriage on patient and cluster level and is defined as the transportation of a severely injured patient (Injury Severity Score ≥ 16) to a lower-level trauma center. Secondary endpoints include overtriage, hospital resource use, and a cost-utility analysis.DiscussionThe TESLA trial will assess the impact of the Trauma Triage App in clinical practice. This novel approach to field triage will give new and previously undiscovered insights into several isolated components of the diagnostic strategy to get the right trauma patient to the right hospital. The stepped-wedge design allows for within and between cluster comparisons.Trial registrationNetherlands Trial Register, NTR7243. Registered 30 May 2018, https://www.trialregister.nl/trial/7038.

Leaving No Large Vessel Occlusion Stroke Behind: Reorganizing Stroke Systems of Care to Improve Timely Access to Endovascular Therapy.

Leaving No Large Vessel Occlusion Stroke Behind: Reorganizing Stroke Systems of Care to Improve Timely Access to Endovascular Therapy.

Emergency Preparedness and Response to the COVID-19 Pandemic: Our Experience from the Emergency Department of a Tertiary Care Hospital in Pakistan.

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Validation of Guidelines for Field Triage of Injured Patients for major trauma in patients of brain and spinal injury.

Validation of Guidelines for Field Triage of Injured Patients for major trauma in patients of brain and spinal injury.

The effect of emergency medical system transport time on in route clinical decline in a rural system.

The emergency medical system (EMS) Field Triage Decision Scheme (FTDS) exists to direct certain injured patients to high-level care facilities. In rural states, this may require long transport durations, with uncertainty about the effects on clinical decline. We investigate adherence to the FTDS and the effect of transport duration on clinical decline in helicopter emergency medical system (HEMS) and ground emergency medical system (GEMS) transport in the Commonwealth of Kentucky. This institutional review board-approved study retrospectively analyzed deidentified data from the 2017 National EMS Information System for Kentucky. Patients were classified using step 1 FTDS criteria (respiratory rate [RR], <10 or >29 breaths per minute; systolic blood pressure (SBP), <90 mm Hg; or Glasgow Coma Scale [GCS] score, <14 points), by mode of transport (HEMS or GEMS), and by arrival at an appropriate center (levels I-III trauma center). Clinical decline was defined in both groups as an in route decrease in GCS of 2 points or greater, a SBP decrease of 1 SD or greater into or within the low range, an RR increase of 1 SD or greater into or within the high range, or an RR decrease of 1 SD or greater into or within the low range. Almost half (46.3%) of step 1 patients were transported to an inappropriate center; the most common reason recorded was "closest facility" (57.8%). The percent of step 1 patients who declined in route increased with prehospital time in both HEMS and GEMS (p < 0.001). Overall, 12.2% of step 1 patients declined during transport, most commonly because of decreasing GCS (median change, -5 points; interquartile range, -3 to -9, in GCS declining patients). Helicopter EMS patients were more likely to meet step 1 criteria at the scene (29.9% vs. 5.8% GEMS, p < 0.001) and to decline (27.8% vs. 6.1% GEMS, p < 0.001). This study demonstrates that, in a rural state, injured patients meeting FTDS step 1 criteria reach levels I to III trauma centers only about half the time. The FTDS step 1 criteria identified patients at higher risk of further prehospital clinical decline. Rather than decline after 1 hour, these data show that an increasing proportion of patients experience clinical decline throughout prehospital transport. Therapeutic, Level IV.

The Suitability of the CdC field Triage for Korean Trauma Care

Purpose: Accurate and appropriate prehospital field triage is essential for a trauma system. The Korean trauma system (established in 2014) uses the trauma field triage algorithm of the United States Centers for Disease Control and Prevention (CDC). This study evaluated the suitability of the CDC field triage criteria for major trauma cases (injury severity score >15) in Korea. Methods: This retrospective cohort study evaluated trauma patients who presented at the authors’ regional trauma center from January 1 to May 7, 2017. The undertriage and overtriage rates of each CDC field triage step were calculated. Receiver operating characteristic curves were constructed, and the area under the curve (AUC) was evaluated for each step. Results: Among the 1,009 enrolled patients, 168 (16.7%) had major trauma. The undertriage/overtriage rates of each step (steps I, II, III, and IV) of CDC field triage were 9.2%/47.4%, 6.3%/50.8%, 4.5%/59.4%, and 5.3%/78.9%, respectively. The AUC values of each CDC triage step were 0.722, 0.783, 0.791, and 0.615, respectively. The AUC values of the separate components of each step (physiologic criteria, anatomic criteria, mechanism- of-injury criteria, and special considerations) were 0.722, 0.648, 0.647, and 0.456, respectively. Conclusions: The CDC field triage system is acceptable, but not ideal, for Korean trauma care. If we follow the protocol, it would be preferable to omit step IV. The Korean Triage and Acuity Scale may be a good indicator for in-hospital triage. However, a new triage protocol that is simple to estimate on-scene while having good performance should be developed.