According to the ACS-COT, an adult trauma patient should be transported to the highest level of trauma center if he or she:

• A. has a systolic blood pressure of less than 110 mm Hg or a heart rate greater than 110 beats/min.
• B. was involved in a motor vehicle crash in which another patient in the same vehicle was killed.
• C. has a GCS score of less than or equal to 13 with a mechanism attributed to trauma.
• D. has a bleeding disorder or takes anticoagulant medications and has any blunt or penetrating injury.

Answer: (C)

Trauma triage relies on physiologic status, neurologic function, and injury mechanism to decide when a patient should go to the highest level trauma center. The Glasgow Coma Scale is a quick measure of consciousness; a score of 13 or lower signals impaired brain function and a higher risk of serious injury. When this neurologic finding occurs in the context of trauma, it strongly indicates the need for the advanced resources and rapid access to specialists available at the top-level centers, such as 24/7 imaging, neurosurgery, and a full trauma team. That combination—altered mental status plus a trauma mechanism—best justifies transport to the highest level center.

Other criteria by themselves are less definitive. A single blood-pressure or heart-rate threshold isn’t the standard trigger for the highest-level center, mechanism alone (even a fatality in the same vehicle) doesn’t confirm the patient’s own injury severity, and anticoagulant use with any injury raises risk but doesn’t automatically mandate the top center without accompanying physiologic or anatomic criteria.