Animal Triage Trauma Score (ATT)
- Dr Andrew Matole, BVetMed, MSc
- Apr 22
- 5 min read
A trauma score is a numerical characterisation of the injuries sustained by a patient from a traumatic incident. It provides an objective assessment of the patient’s clinical status. The animal triage trauma (ATT) score was developed to stratify the veterinary trauma population by injury severity. The ATT score was designed to be a quick, easy, and readily available tool during emergencies before extensive diagnostics and therapeutic intervention are implemented. The ATT score is a significant predictor of survival in both dogs and cats. In dogs, an increase of 1 point in the ATT score is associated with a 2.07-fold increase in the odds of non-survival. In cats, a 1-point increase in the ATT score is associated with a 1.79-fold increase in the odds of non-survival.
What are the parameters for the scoring system?
Six categories are considered for the Animal Trauma Triage Score (see ATT score table):
Perfusion.
Cardiac.
Respiratory.
Eye/Muscle/Integument.
Skeletal.
Neurological.
Each category is scored 0-3 (0 = no injury, 3 = severe injury). Even though a total score of 18 is possible, not all categories have been found to be equally predictive of survival. Perfusion, neurological and respiratory are the most predictive of survival.
Predictive summary of ATT Scores
Higher ATT scores are associated with a higher likelihood of blood transfusion dependency in dogs hospitalised following trauma.
Higher ATT scores are also associated with increased odds of developing acute traumatic coagulopathy in dogs, which is not replicated in cats.
In dogs presented with rib fractures (thoracic wall trauma), the ATT scores correlated positively with mortality. Specifically, an ATT score of ≥ 7 is 88% sensitive and 81% specific for predicting non-survival.
In cats with poly-trauma, an ATT score >5 has a 78.6% sensitivity and 79.2% specificity to predict non-survival.
In cats with pelvic trauma, increasing ATT scores are associated with increased odds of requiring blood transfusions and non-survival.
In cats treated surgically for thoracic trauma, lower ATT scores are associated with higher survival rates.
In dogs undergoing surgery for thoracic trauma, an ATT score of < 7 indicated a 5-fold increase in survival odds compared to an ATT score ≥ 7.
In dogs and cats with gunshot injuries, an ATT score of > 4.5 is associated with a poorer outcome, longer hospitalisation, use of blood products and need for surgical intervention.
The ATT score table
Category | Score = 0 | Score = 1 | Score = 2 | Score = 3 |
Perfusion  | MM pink & moist, CRT = 2 sec Rectal temperature > 37.8 °C Strong femoral pulses | MM hyperaemic or pale/pink and tacky CRT 0-2 sec Fair femoral pulses | MM very pale/pink and tacky. CRT 2-3 sec Rectal temperature <37.8°C Poor femoral pulses | MM grey/blue or white CRT>3 sec Rectal temperature < 37.8 Femoral pulses not detected |
Cardiac  | HR 60-140 bpm (dogs) or 120-200 (cats) Normal sinus rhythm | HR 140-180 bpm (dogs) or 200-260 bpm. (cats) Sinus rhythm or VPCs < 20/min | HR >180 bpm (dogs) or >260 bpm (cats) Consistent arrhythmia | HR <60 bpm (dogs) or <120 (cats) Erratic arrhythmia |
Respiratory  | Regular respiratory rate No stridor No abdominal component | Mildly increased respiratory rate and effort Some abdominal component Mildly increased upper airway sounds | Moderately increased respiratory effort Abdominal component Elbow abduction Moderately increased upper airway sounds | Marked respiratory effort, or gasping/agonal respiration, or irregularly timed effort Little or no detectable air passage |
Eyes 
Muscles  Integument (Skin)  | No abrasions or partial-thickness lacerations No fluorescein uptake on corneas | -thickness | Full-thickness lacerations with deep tissue involvement Intact arteries, nerves and muscles Corneal perforation, punctured globe or proptosis | Penetration into thoracic or abdominal cavity Full thickness lacerations with deep tissue involvement and artery, nerve or muscle compromise |
Skeletal  | Weight bearing in 3-4 limbs No palpable fracture or joint laxity | Closed appendicular or rib fractures or any mandibular fractures Single joint laxity/luxation, including sacroiliac joint Pelvic fracture with unilateral intact SI-ilium-acetabulum Single limb open/closed fracture at or below the carpus/tarsus | Multiple Score 1 conditions Single long bone open fracture above carpus/tarsus with preserved cortical bone Non-mandibular skull fractures | Ventral body fracture/luxation except coccygeal Multiple long bone open fractures above the tarsus/carpus Single long bone open fracture above tarsus/carpus with loss of cortical bone |
Neurological  | Conscious, alert or slightly dull but still interested in surroundings Normal spinal reflexes, purposeful movement and nociception in all limbs | Conscious but dull, depressed and withdrawn Abnormal spinal reflexes with purposeful movement and nociception intact in all four limbs | Unconscious but responding to noxious stimuli Absent purposeful movement with intact nociception in 2 or more limbs or nociception absent only in 1 limb Decreased anal and/or tail tone | Non-responsive to all stimuli Refractory seizure activity Absent nociception in 2 or more limbs Absent tail or perianal nociception |
MM = mucous membranes; CRT = capillary refill time; HR = heart rate
The ATT score, then, provides a very helpful tool for objectively identifying patients who may require more intense monitoring, additional procedures (such as blood transfusions), or aggressive trauma management due to their more severe injuries. A high ATT score alone should not be used to justify the euthanasia of any animal because it is not an absolute prognostic indicator.
References
Canine Anatomy for Beginners. (2026.). Muscular structure. WordPress. https://canineanatomyforbeginners.wordpress.com/muscular-struture/
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