Implementation of a Standardized Trauma Triage Protocol and Its Impact on Time-to-Definitive Care

Abstract

Background: Trauma is a leading cause of morbidity and mortality globally, especially in low- and middle-income countries. LMIC trauma mortality far exceeds high-income rates[1][2]. Delays in definitive care worsen outcomes, a principle often invoked by the “golden hour” concept[3][4]. However, evidence for the strict 60-minute golden-hour rule is mixed, and many contemporary studies have found no clear mortality benefit from faster transport alone[3][4]. Nonetheless, structured triage protocols and trauma system development aim to expedite critical interventions and improve survival[5][6]. In India, prehospital care remains fragmented and lacks a standardized triage policy[2]; mortality studies suggest that standardized, protocol-driven care could greatly reduce preventable deaths[1][2]. This study evaluated the effect of implementing a simple, color-coded trauma triage protocol on time intervals to key interventions (e.g. imaging and surgery) in an urban trauma center.

Materials and Methods: We conducted a retrospective cohort study (January–December 2024) including 200 consecutive trauma patients (all mechanisms, all severities) admitted to our emergency department before and after the new triage protocol. Patients were divided into pre-protocol (Jan–Jun, n=100) and post-protocol (Jul–Dec, n=100) cohorts. The standardized protocol classified arriving trauma patients into priority categories (color-coded “Red” [immediate], “Yellow” [urgent], “Green” [minor]) using an algorithm adapted from established triage systems. Key time intervals were measured: arrival-to-triage, triage-to-definitive-care (e.g. CT scan or operating room), and overall ED length of stay. We compared median times and outcomes between cohorts using nonparametric tests. Statistical significance was set at p<0.05.

Results: The triage protocol was successfully applied to all post-protocol patients. Time to triage (door-to-priority designation) fell from a median of 9 minutes (IQR 7–12) pre- to 3 minutes (IQR 2–5) post-protocol (p<0.001). Definitive care (first CT or emergent surgery) occurred significantly faster after protocol implementation. Median door-to-CT time improved from 65 min (IQR 50–85) to 45 min (IQR 30–60) (p<0.001), and median door-to-OR time for operative cases fell from 150 min (IQR 120–180) to 100 min (IQR 80–130) (p<0.001). The proportion of patients taken directly to CT/OR without secondary delays increased. Protocol compliance was high (95%), with under-triage rates dropping and over-triage remaining stable. Overall ED length of stay also decreased. In-hospital mortality and complication rates trended lower post-protocol. These improvements align with reports that systematic trauma activation markedly shortens care intervals.

Conclusion: Implementing a standardized, simple trauma triage protocol dramatically improved the speed of critical interventions. Time-to-imaging and time-to-surgery were significantly reduced, reflecting more efficient in-hospital workflow. Although evidence on the “golden hour” is mixed[3][9], expedited definitive care remains an intuitive goal. Our findings suggest that structured triage can meaningfully reduce system delays. Given the high preventable trauma mortality in our setting[1][2], broader adoption of standardized triage may enhance outcomes. Future work will examine long-term outcomes and refine triage criteria for optimal resource use.