CRAMS scale: field triage of trauma victims.

A simple 10-point scale was devised for the purpose of determining which trauma patients should go to a trauma center. The acronym "CRAMS" represents the five components measured: Circulation, Respiration, Abdomen, Motor, and Speech. The results of field triage were compared to final emergency department (ED) disposition. Those patients who died in the ED and those who went directly to the operating room (OR) for general surgery or neurosurgery were defined as major trauma. Of 12 patients defined as major trauma by ED disposition, 11 were defined as major trauma (CRAMS less than or equal to 8) in the field (sensitivity, 92%). This was compared to 8 defined as major trauma by Champion's Trauma Score. Of 313 defined as minor trauma by ED disposition (discharged home), 307 were defined as minor trauma (CRAMS greater than or equal to 9) in the field (specificity, 98%). The CRAMS scale provides an effective net for major trauma while ensuring that minor trauma is not unnecessarily diverted to a trauma center.