Advanced Trauma Life Support (ATLS) Interhospital Transfer Criteria

The following is the criteria for transferring patients from hospitals with limited capabilities to trauma centers:

Interhospital Transfer Criteria, ATLS Table 13.1*
Category Specific Injuries and Other Factors
Central Nervous System
  • Head injury
  • Penetrating injury or depressed skull fracture
  • Open injury with or without cerebrospinal fluid (CSF) leak
  • GCS score < 15 or neurologically abnormal
  • Lateralizing signs
  • Spinal cord injury or major vertebral injury
  • Widened mediastinum or signs of great vessel injury
  • Major chest wall injury or pulmonary contusion
  • Cardiac injury
  • Patients who may require prolonged ventilation
  • Unstable pelvic ring-disruption
  • Pelvic-ring disruption with shock and evidenc of continuing hemorrhage
  • Open pelvic injury
  • Solid organ injury
  • Severe open fractures
  • Traumatic amputation with the potential for replantation
  • Complex Articular Injuries
  • Major crush injuries
  • Ischemia
Multisystem Injuries
  • Multisystem injury with face, chest, abdominal, or pelvic injury
  • Injury to more than two body regions
  • Major burns or burns with associated injuries
  • Multiple prolonged long-bone fracture
Comorbid Factors
  • Age > 55 years
  • Children < 5 years of age
  • Cardiac or respiratory disease
  • Insulin-dependent diabetes
  • Morbid obesity
  • Pregnancy
  • Immunosupression
Secondary Deterioration (Late Sequelae)
  • Mechanical ventilation required
  • Sepsis
  • Single or multiple organ system failure (deterioration in central nervous system , cardiac, pulmonary, hepatic, renal, or coagulation systems)
  • Major tissue necrosis

You don’t need imaging tests such as CT scans if you know you are going to transfer the patient regardless of the results and when the results will not change management at the local hospital. Patients who need transfer for comprehensive care need it as quickly as possible. If in doubt about a whether a study is needed at the local hospital, it would be reasonable to ask the trauma center surgeon who will be accepting the patient.


Stable patients with blunt abdominal trauma and documented liver or spleen injury may be candidates for nonoperative management. Implicit in such practice is the immediate availability of an operating room and a qualified surgical team. A general or trauma surgeon should supervise nonoperative management, regardless of the patient’s age. Such patients should not be treated expectantly at facilities that are not prepared for operative intervention; they should be transferred to a trauma center.”*

*Advanced Trauma Life Support Student Course Manual, 9th ed, c. 2013, American College of Surgeons,Chapter 13: Determining the need for patient transfer. pp. 300 and 301.

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