The authors objective was to develop and test a single branch-chain decision tree for blunt and penetrating truncal injury. Over the 4-month study period there were 979 patients evaluated in the emergency department; 674 of these patients were admitted to the hospital. Thirty-four (5%) of the 674 admitted patients died of truncal injury. The study group consisted of 239 of the most severely injured patients; 41 of these (17%) died. Of the 44 patients managed with major deviations from the algorithm, 27 (61%) died. Only 14 of the 195 patients (7%) whose management complied with the algorithm died. The authors conclude that following the specific management criteria outlined by the algorithm may improve the survival of severely traumatized patients.