Table 1 Classification of life- and limb-threatening injuries and bleeding [7,8,9,10]

Life-threatening injuries

Head

Mayo Classification (Moderate/Severe TBI)

Hematoma (Intracerebral, Subdural, or Epidural), Contusion (Cerebral or Hemorrhagic), Penetrating TBI (dura penetrated), Subarachnoid hemorrhage, Brain Stem Injury

Thorax

AAST Injury Scale ≥ 3

 Chest Wall

Flail Chest, Flail sternum, Avulsion of chest wall with underlying rib fractures

 Heart

Blunt and penetrating cardiac injury, Cardiac tamponade, Avulsion of the heart

 Haemothorax

NA

Hemothorax with > 20% blood loss, shocked (shock index > 0.9) or significant on-scene blood loss

 Vascular

Arteries: Carotid, Innominate, Subclavian, Thoracic Aorta, Pulmonary (main trunk, and primary intraparenchymal branch)

Veins: Superior and Inferior vena cava, Pulmonary (main trunk, and primary intraparenchymal branch)

Abdomen

AAST Injury Scale ≥ 3

 Liver

Any injury in the presence of a liver vascular injury or active bleeding; intraparenchymal laceration > 10 cm; ruptured liver hematoma; subcapsular hematoma > 50% surface area

 Spleen

Any injury involving splenic vascular injury or active bleeding; parenchymal laceration > 3 cm depth; ruptured splenic hematoma; subcapsular hematoma > 50% surface area

 Kidney

Any injury in the presence of a kidney vascular injury or active bleeding

 Vascular

Arteries: Abdominal Aorta, Coeliac, Superior mesenteric, Renal, Iliac

Veins: Inferior Vena Cava, Portal, Superior mesenteric, Renal, Iliac

 Hollow organs

Bowel devascularisation, transection or disruption of > 50% of circumference

Laceration (biliary, pancreas, extrahepatic bile duct), gallbladder avulsion, distal pancreas transection or parenchymal injury with duct injury, proximal pancreas transection or parenchymal injury involving ampulla, massive disruption of pancreatic head

Pelvis

AO/OTA classification (B/C)

B- Incomplete posterior arch disruption

C- Complete posterior arch disruption

Limb-threatening injuries

Spine

 Spinal Fracture

Denis

Any spinal fracture with 2 + spinous ligament injury, Chance fracture, Vertebral body < 50% loss, Hangman’s fracture, Jefferson’s fracture

 Spinal cord

NA

Any Spinal cord injury

Extremity

 Long Bone Fracture

NA

Any Humerus, Radius, Ulna, Femur or Tibia fracture

 Vascular

AAST Injury Scale ≥ 3

Arteries: Brachial, Axillary, Anterior tibial, Posterior tibial, Peroneal, Tibioperoneal trunk, Femoral (superficial, deep and common)

Veins: Superficial or deep femoral, Popliteal

Life-threatening bleeding

Thoracic Hemorrhage

AAST Injury Scale ≥ 4

Thoracic Vascular injury involving aorta, vena cava, or major pulmonary artery or vein. Cardiac injury with disruption of an atrium or ventricle

Hemothorax with > 20% blood loss or shock (shock index > 0.9)

Abdominal Hemorrhage

AAST Injury Scale ≥ 4

Abdominal Vascular injury involving superior mesenteric artery, celiac axis, vena cava, aorta, portal vein injury, or any injury with > 20% blood loss

Liver: Any injury in the presence of a liver vascular injury or active bleeding; parenchymal disruption > 25% of lobe

Spleen: Any injury involving splenic vascular injury or active bleed

Kidney: Any injury in the presence of a kidney vascular injury or active bleed