The American College of Surgeons Committee on Trauma (ASC/COT) proposed clinical findings useful to triage patients. Tinkoff and O’Connor validated the rules and developed an equation to predict mortality. The latter two authors are from the Christiana Health System in Newark, Delaware.


Triage rules:

(1) low systolic blood pressure (< 90 mm Hg)

(2) Glasgow coma score (GCS) < 8

(3) airway compromise requiring endotrachial intubation or a surgical airway

(4) penetrating gunshot wound (GSW) to head, neck, thorax or abdomen (head or torso)

(5) transfer from another hospital receiving blood to maintain vital signs

(6) discretion of ED physician



• The abstract by Tinkoff and O’Connor had a penetrating wound to the head or torso rather than a gunshot wound.


Tinkoff and O’Connor found that the first 4 criteria correlated with urgent surgery, ICU admission and mortality. The logistic regression model for mortality was (with 0 if risk factor absent and 1 if present):


X =

= (0.0912 * (penetrating GSW)) + (2.2942 * (GCS)) + (1.8363 * (hypotension)) + (2.2768 * (emergency airway)) – 4.98


probability of mortality =

= 1 / (1 + EXP((-1)*X))


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