Physical findings strongly associated with critical injury

Vital signs and level of consciousness

GCS <14

Shock (compensated or uncompensated)*

RR lower or higher than normal for age^¶

Anatomy of injury

Airway trauma with respiratory distress, anterior neck tenderness, or deformity

Chest trauma with persistent tachycardia, chest tenderness, or deformity with respiratory distress

Abdominal tenderness or distension with persistent tachycardia

Pelvic fracture

Two or more proximal long-bone fractures

Amputation proximal to wrist or ankle

Crushed, mangled, or degloved extremity

Open or depressed skull fracture

Paralysis

Penetrating trauma to head, neck, chest, abdomen, or proximal extremities

GCS: Glasgow coma scale.
* Compensated shock presents with tachycardia and poor perfusion but normal blood pressure. Uncompensated shock manifests as tachycardia and signs of inadequate perfusion with hypotension for age (See text entitled "Unique pediatric considerations" for discussion of vital signs in children and shock).
¶ See Unique pediatric considerations, section on pediatric physiology.

Reference: American College of Surgeons Committee on Trauma. Resources for optimal care of the injured patient 2006. American College of Surgeons, Chicago, IL, 2006, p. 22.

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Physical findings strongly associated with critical injury