Table 1.

UK consensus definition of injury benefiting from major trauma centre care.

Domain	Critical interventions	Individual anatomical injuries	Multiple minor injuries	Patient attributes
Rationale	Injury requiring a time-critical trauma-related intervention only available, or more effectively delivered, in an MTC	Presence of significant individual anatomical injuries that would benefit from expedited MTC care	Presence of multiple injuries, non-significant in isolation, but cumulatively resulting in significant injury that would benefit from expedited MTC care	Exclusion of patients who do not want, or would not benefit from, expedited MTC care
Criteria	Resuscitation requiring any of: Emergency intubation Ventilation Blood product transfusion Indication for an emergency trauma-related surgical procedure (including ICP monitoring) Indication for emergency trauma-related interventional radiology Requirement for multidisciplinary critical care admission	Most AIS 4+ injuries, e.g. spinal injury with neurological deficit (unless can be satisfactorily managed in a non-MTC) Specific AIS <4 injuries: Significant de-gloving injury Open long bone fractures Amputations proximal to the fingers/toes Pelvic ring fractures (excluding osteoporotic fractures) Chest injuries with respiratory failure TBI causing GCS <9 if clinical frailty score <6 (residential home level care) TBI causing GCS 9–13 if clinical frailty score <6 and focal neurology or pupillary abnormalities Complex skull fractures: large, depressed areas, open with exposed brain, CSF leak	AIS injuries in 2+ body regions combining to ISS ≥16; total ISS ≥16 calculated by either: If presence of an AIS 4+ injury excluded from significant isolated injuries, then requires AIS 2+ injury in second body region If no AIS 4+ injury excluded from significant injuries, then include all AIS codes, except: Exclude all AIS = 1 Exclude all non-skeletal face AIS codes Exclude head region AIS codes in patients with clinical frailty score >=6 Exclude all ‘external and thermal’ and ‘other’ region codes Exclude ingestions and hypoxic brain injuries	Applicable advanced directives Clinical frailty score ≥7 (nursing home-level care) Un-survivable injuries, e.g. torso transection, massive brain destruction, decapitation Traumatic cardiac arrest >15 minutes transport from MTC

AIS: Abbreviated Injury Scale; CSF: cerebrospinal fluid; GCS: Glasgow Coma Scale; ICP: intracranial pressure monitoring; MTC: major trauma centre; TBI: traumatic brain injury.