<p>Operative triage of abdominal trauma, whether blunt or penetrating, remains a major challenge in emergency care. Although quantitative decision-support tools, such as Pediatric Emergency Care Applied Research Network (PECARN) rule, Focused Assessment with Sonography in Trauma (FAST), Shock Index, Pediatric Age-Adjusted (SIPA), and Blunt Abdominal Trauma Scoring System (BATSS), are widely used, they do not fully capture the complex clinical reasoning and experiential judgment required for real-world decision-making. This limitation is particularly important because blunt and penetrating abdominal trauma differ substantially in their pathophysiology, injury patterns, and management priorities. This qualitative study explored the patient-related factors influencing surgical prioritization (operative triage) of abdominal trauma from the perspectives of clinicians involved in trauma care. This qualitative study used a conventional content analysis approach. Ten clinicians with direct experience in abdominal trauma triage were purposively recruited from teaching hospitals affiliated with Dezful University of Medical Sciences, Iran. Participants included five specialist physicians (two anesthesiologists, one general surgeon, and two emergency medicine physicians) and five nursing and allied health professionals (two nurses with PhDs in Nursing, one nurse with a Master’s degree, one surgical technologist with a Master’s degree, and one Master’s-level anesthesia professional). Data were collected through ten in-depth, semi-structured interviews and analyzed manually using the five-step content analysis method proposed by Graneheim and Lundman. Trustworthiness was established according to Lincoln and Guba’s criteria. Analysis identified three main categories and ten subcategories influencing operative triage of abdominal trauma: physiological status (vital signs, respiratory distress, indicators of shock, level of consciousness, and associated neurological injury), individual and contextual characteristics (age, pregnancy, and comorbidities), and injury severity and pattern (limb injuries, extra-abdominal trauma, and head injury). Clinicians consistently distinguished between blunt and penetrating abdominal trauma during surgical prioritization. In blunt trauma, concealed hemorrhage, hemodynamic instability, and imaging findings suggestive of solid organ injury were the primary determinants of urgency. In penetrating trauma, injury trajectory, peritoneal violation, and the need for immediate surgical exploration were prioritized. Participants described operative triage as a dynamic process that integrates multiple clinical cues, contextual information, and professional experience rather than relying solely on algorithm-based protocols. Operative triage of abdominal trauma is a multidimensional clinical decision-making process that extends beyond standardized scoring systems and fixed numerical thresholds. Surgical prioritization requires the simultaneous integration of injury mechanism, physiological status, patient characteristics, and contextual clinical information. These findings underscore the importance of combining evidence-based protocols with experienced clinical judgment, particularly when managing patients with multisystem trauma, complex injuries, or atypical presentations. Incorporating these factors into trauma education, clinical training, and future decision-support systems may improve the accuracy, consistency, and timeliness of operative triage for patients with abdominal trauma.</p>