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Revised Trauma Score (RTS)

Puntuación GCS codificada (0–4)

Systolic BP coded (0–4)

Frecuencia respiratoria codificada (0–4)

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Qué es Revised Trauma Score (RTS)?

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The Revised Trauma Score (RTS) is a physiological scoring system used to assess the severity of injury and predict the probability of survival in trauma patients. Developed by Champion et al. in 1989 as an update to the original Trauma Score, the RTS uses three readily obtainable parameters: the Glasgow Coma Scale (GCS), systolic blood pressure (SBP), and respiratory rate (RR). Each parameter is coded on a 0–4 scale using predefined ranges, and the coded values are weighted and summed using the formula: RTS = 0.9368×GCS_coded + 0.7326×SBP_coded + 0.2908×RR_coded. The RTS ranges from 0 to 12, where higher values indicate less physiological derangement and better predicted survival. An RTS below 4 is generally indicative of major trauma requiring immediate resuscitation and highest-level trauma centre care. The RTS is a key component of the Trauma and Injury Severity Score (TRISS) methodology, which combines RTS with the Injury Severity Score (ISS) from anatomical injury assessment and patient age to generate a probability of survival (Ps). TRISS allows comparison of actual versus predicted survival across trauma centres, providing a quality benchmarking tool. In pre-hospital settings, a simplified version called the Triage Revised Trauma Score (T-RTS) uses unweighted coded values (summed directly) to enable rapid field triage, with T-RTS less than 12 indicating immediate transport to a major trauma centre. The RTS has been validated in multiple large trauma databases and remains foundational to trauma system design and major incident triage worldwide.

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Fórmula

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Trauma Score Calculation:
  Step 1: Step 1 — Measure GCS: Assess eye, verbal, and motor responses. Obtain GCS total (3–15).
  Step 2: Step 2 — Code GCS: 13–15 → 4; 9–12 → 3; 6–8 → 2; 4–5 → 1; 3 → 0.
  Step 3: Step 3 — Measure SBP: Obtain systolic blood pressure in mmHg. Code: >89 → 4; 76–89 → 3; 50–75 → 2; 1–49 → 1; 0 → 0.
  Step 4: Step 4 — Measure RR: Count respiratory rate per minute. Code: 10–29 → 4; >29 → 3; 6–9 → 2; 1–5 → 1; 0 → 0.
  Step 5: Step 5 — Apply weighted formula: RTS = (0.9368 × GCS_coded) + (0.7326 × SBP_coded) + (0.2908 × RR_coded).
  Step 6: Step 6 — Interpret RTS: Maximum score 12 = normal physiology; 0 = no detectable physiological function. RTS <4 defines major trauma.
  Step 7: Step 7 — Combine with ISS for TRISS: Use RTS alongside Injury Severity Score (ISS) and age to calculate probability of survival using the TRISS logistic regression equation.

Each step builds on the previous, combining the component calculations into a comprehensive trauma score result. The formula captures the mathematical relationships governing trauma score behavior.

Cómo Revised Trauma Score (RTS)

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1Step 1 — Measure GCS: Assess eye, verbal, and motor responses. Obtain GCS total (3–15).
2Step 2 — Code GCS: 13–15 → 4; 9–12 → 3; 6–8 → 2; 4–5 → 1; 3 → 0.
3Step 3 — Measure SBP: Obtain systolic blood pressure in mmHg. Code: >89 → 4; 76–89 → 3; 50–75 → 2; 1–49 → 1; 0 → 0.
4Step 4 — Measure RR: Count respiratory rate per minute. Code: 10–29 → 4; >29 → 3; 6–9 → 2; 1–5 → 1; 0 → 0.
5Step 5 — Apply weighted formula: RTS = (0.9368 × GCS_coded) + (0.7326 × SBP_coded) + (0.2908 × RR_coded).
6Step 6 — Interpret RTS: Maximum score 12 = normal physiology; 0 = no detectable physiological function. RTS <4 defines major trauma.
7Step 7 — Combine with ISS for TRISS: Use RTS alongside Injury Severity Score (ISS) and age to calculate probability of survival using the TRISS logistic regression equation.

Ejemplos resueltos

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Ejemplo 1Minor Trauma — Normal Physiology

Dado:GCS 15, SBP 130 mmHg, RR 16/min

Resultado:RTS = 0.9368×4 + 0.7326×4 + 0.2908×4 = 7.84 (Normal physiology)

Maximum coded values; predicted survival >98% in isolation

GCS 15 → code 4; SBP 130 → code 4; RR 16 → code 4. RTS = (0.9368×4)+(0.7326×4)+(0.2908×4) = 3.747+2.930+1.163 = 7.84.

Ejemplo 2Moderate Trauma

Dado:GCS 11, SBP 95 mmHg, RR 22/min

Resultado:RTS = 0.9368×3 + 0.7326×4 + 0.2908×4 = 6.86 (Moderate trauma)

Activate trauma team; CT pan-scan; monitor for deterioration

GCS 11 → code 3; SBP 95 → code 4; RR 22 → code 4. RTS = (0.9368×3)+(0.7326×4)+(0.2908×4) = 2.810+2.930+1.163 = 6.903.

Ejemplo 3Severe Trauma

Dado:GCS 7, SBP 80 mmHg, RR 8/min

Resultado:RTS = 0.9368×2 + 0.7326×3 + 0.2908×2 = 4.25 (Severe)

Major trauma centre; immediate resuscitation; RSI likely required

GCS 7 → code 2; SBP 80 → code 3; RR 8 → code 2. RTS = (0.9368×2)+(0.7326×3)+(0.2908×2) = 1.874+2.198+0.582 = 4.654.

Ejemplo 4Critical Trauma — Near Arrest

Dado:GCS 3, SBP 40 mmHg, RR 4/min

Resultado:RTS = 0.9368×0 + 0.7326×1 + 0.2908×1 = 1.02 (Critical — predicted survival <10%)

Immediate life-saving intervention; massive haemorrhage protocol; emergency surgery

GCS 3 → code 0; SBP 40 → code 1; RR 4 → code 1. RTS = 0 + 0.7326 + 0.2908 = 1.023. This is near the minimum — immediate resuscitation critical.

Aplicaciones prácticas

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Pre-hospital triage to determine need for direct transport to a major trauma centre (T-RTS), representing an important application area for the Trauma Score in professional and analytical contexts where accurate trauma score calculations directly support informed decision-making, strategic planning, and performance optimization

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TRISS probability of survival calculation for trauma system audit and quality benchmarking, representing an important application area for the Trauma Score in professional and analytical contexts where accurate trauma score calculations directly support informed decision-making, strategic planning, and performance optimization

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Major incident and mass casualty triage to allocate limited resources to highest-priority survivors, representing an important application area for the Trauma Score in professional and analytical contexts where accurate trauma score calculations directly support informed decision-making, strategic planning, and performance optimization

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Academic researchers and university faculty use the Trauma Score for empirical studies, thesis research, and peer-reviewed publications requiring rigorous quantitative trauma score analysis across controlled experimental conditions and comparative studies

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Retrospective trauma registry analysis and international comparison of trauma system performance, representing an important application area for the Trauma Score in professional and analytical contexts where accurate trauma score calculations directly support informed decision-making, strategic planning, and performance optimization

Casos especiales

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Alcohol or Drug Intoxication

In the Trauma Score, this scenario requires additional caution when interpreting trauma score results. The standard formula may not fully account for all factors present in this edge case, and supplementary analysis or expert consultation may be warranted. Professional best practice involves documenting assumptions, running sensitivity analyses, and cross-referencing results with alternative methods when trauma score calculations fall into non-standard territory.

Compensated Haemorrhagic Shock

Penetrating Head Injury

RTS Parameter Coding Table

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Parameter	Range	Coded Value
GCS	13–15	4
GCS	9–12	3
GCS	6–8	2
GCS	4–5	1
GCS	3	0
SBP (mmHg)	>89	4
SBP (mmHg)	76–89	3
SBP (mmHg)	50–75	2
SBP (mmHg)	1–49	1
SBP (mmHg)	0	0
RR (/min)	10–29	4
RR (/min)	>29	3
RR (/min)	6–9	2
RR (/min)	1–5	1
RR (/min)	0	0

Preguntas frecuentes

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What is the difference between RTS and T-RTS?

The Revised Trauma Score (RTS) uses weighted coefficients for physiological scoring and is used in hospital-based TRISS calculations. The Triage RTS (T-RTS) uses unweighted summed coded values (max 12) for rapid pre-hospital triage — T-RTS <12 indicates need for major trauma centre. T-RTS is faster to calculate at the scene without a calculator.

What is TRISS and how does RTS fit into it?

TRISS (Trauma Injury Severity Score) combines the RTS (physiological), ISS (anatomical — Injury Severity Score), and patient age to calculate the probability of survival (Ps) using a logistic regression equation. Ps = 1 / (1 + e^-b) where b = b0 + b1×RTS + b2×ISS + b3×Age_index. It allows trauma system quality benchmarking by comparing actual versus predicted survival.

Why are the RTS coefficients not equal (0.94, 0.73, 0.29)?

The coefficients were derived by logistic regression analysis of the Major Trauma Outcome Study database to maximise predictive accuracy for survival. GCS has the highest coefficient (0.9368) because neurological status is the strongest single predictor of trauma outcome. SBP is next (0.7326) as a haemodynamic marker, with RR contributing least (0.2908) in isolation.

Is RTS still widely used today?

Yes, RTS remains the standard physiological scoring component in TRISS and is embedded in most major trauma system databases (TARN, NTDB). However, many centres supplement it with lactate, base deficit, and coagulation markers for a more complete physiological assessment. Newer scores like the Revised Injury Severity Classification (RISC) incorporate more variables.

How is the Revised Trauma Score (RTS) calculated?

The Revised Trauma Score (RTS) is calculated by assigning coded values (0-4) to a patient's Glasgow Coma Scale (GCS), Systolic Blood Pressure (SBP), and Respiratory Rate (RR). These coded values are then multiplied by specific coefficients and summed. The formula is: RTS = (0.9368 × GCS_coded) + (0.7326 × SBP_coded) + (0.2908 × RR_coded). For instance, a patient with GCS 15 (coded 4), SBP >89 mmHg (coded 4), and RR 10-29 breaths/min (coded 4) would yield an RTS of 0.9368*4 + 0.7326*4 + 0.2908*4 = 7.8408, representing the maximum possible score.

Errores comunes a evitar

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!Using GCS total without coding it to 0–4 before applying the weighted formula, producing an invalid result.
!Confusing T-RTS (unweighted, max 12 pre-hospital triage) with RTS (weighted, max 7.84 for TRISS) — the scales are different.
!Treating RTS as equivalent to TRISS survival probability — RTS is only one component; ISS and age are also required.
!Failing to document the time of RTS assessment — pre-hospital and hospital arrival values serve different purposes.
!Applying adult RTS coefficients directly to paediatric patients without age-appropriate physiological norm adjustment.
!Using a single RTS as a futility criterion — RTS must be integrated with full clinical assessment, mechanism, and imaging.

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Consejo Pro

In the field, use T-RTS as a rapid mental calculation — code each parameter 0–4 and sum. Any patient with a T-RTS below 12 (i.e., any parameter not at maximum) meets criteria for direct transport to a major trauma centre. In hospital, use the weighted RTS for TRISS-based audit and outcome benchmarking.

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¿Sabías que?

The original Trauma Score (Champion et al. 1981) included capillary refill time and respiratory expansion, making it cumbersome to use in dim pre-hospital lighting. The 1989 Revised Trauma Score removed these components in favour of the three measurable parameters we use today — a prime example of clinical scoring being simplified for real-world usability.

Referencias

📖Dificultad:Intermedio

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Revised Trauma Score (RTS)