Criteria for level 1 and level 2 trauma codes: Are pelvic ring injuries undertriaged?

Table 1 Inclusion criteria for designation as a level 1 trauma code at the author’s home institution

Level 1 adult trauma code criteria
Cardiac arrest (secondary to trauma)
Airway compromise, poor ventilation, or high potential for same (includes assisted ventilations, field intubation, referring facility intubation compromise, or inability to intubate)
Hypotension or shock (Systolic BP < 90 mmHg adults and age specific hypotension)
GCS ≤ 8 (Presumably due to trauma)
GSW to neck or torso (chest, back, abdomen, or groin), or extremity proximal to the elbow/knee
Receiving blood transfusion at any time prior to arrival to maintain vital signs (transfer patients, air transport)
Emergency physician discretion
Patients who develop any level 1 criteria during their Emergency Department stay should be upgraded to a level 1 trauma code

GCS: Glasgow coma scale; GSW: Gunshot wound.

Table 2 Inclusion criteria for designation as a level 2 trauma code at the author’s home institution

Level 2 adult trauma code criteria
Heart rate < 50 or > 125 (> 100 if age > 65 yr)
Systolic BP < 110 mmHg (only if age > 65 yr)
Respiratory rate < 10 or > 29
GCS ≤ 10
Stab to neck or torso (chest, back, abdomen, or groin)
GSW head (without airway compromise)
Amputation proximal to knee or elbow
Two or more proximal long bone fractures
Crush injury to chest or pelvis
Paralysis/suspected spinal cord injury
Neurovascular compromise of an extremity
Age > 65 yr + anticoagulant use + significant trauma
Intubation at outside hospital (transfer patients)
Multisystem trauma on outside imaging (transfer patients)
Emergency physician discretion

GCS: Glasgow coma scale; GSW: Gunshot wound.

Table 3 Numbers of unstable and stable pelvic fractures in level 1 compared to level 2 trauma code patients. Further stratified percentages of the outcomes of these patients (discharged home, discharged to rehabilitation facility, or died)

Trauma level	Stable or unstable	Discharged home	Discharged to rehabilitation facility	Died
Level 1 108 patients	Stable (72/108) 67%	38%	39%	24%
	Unstable (36/108) 33%	33%	36%	32%
Level 2 130 patients	Stable (81/130) 62%	77%	17%	5%
	Unstable (49/130) 38%	65%	31%	4%