Revised Trauma Score (RTS) is a scoring system which considers the physiological response to trauma. It is used by intensive care specialists and emergency physicians to determine the health status of the patient and the survival probability. Using only three simple clinical data which are assessed in every patient in an emergency makes it feasible in every situation.

Read on if you want to find out:

What pathophysiological changes happen in trauma?
Why do you need to use RTS?
How to calculate RTS?
What does the result tell you?

The pathophysiology of trauma

Major trauma is an injury that may lead to death or disability. According to WHO it is one of the leading causes of death worldwide. Regardless the cause and type of the injury, pathophysiological changes lead to decreased organ perfusion, cellular ischemia, and a cascade of edema and inflammation what causes fever, altered mental status and increased heart rate, cardiac output and metabolism.

The more severe the trauma, the more intensified pathophysiological changes and the poorer prognosis of the patient.

Why should we calculate RTS?

The scientists develop trauma score systems to describe the severity of injuries or the prognosis of a patient (which correlates with seriousness) with a single numerical value. The purpose of trauma scales is to improve and simplify communication about trauma cases and to support decision making in the individual patient.

How to calculate RTS?

Revised Trauma Score derived from the original Trauma Score published by Champion and associates in Critical Care Medicine. The Revised Trauma Score provides a general assessment of physiological derangement due to trauma. It combines coded measurements of:

The results from that measurements are given values as follows:

GCS	Value	SBP	Value	RR	Value
15-13	4	>89	4	10-29	4
12-9	3	76-89	3	>29	3
8-6	2	>50-75	2	6-9	2
5-4	1	>1-49	1	1-5	1
3	0	>0	0	0	0

The coded value is multiplied by a weighting factor derived from regression analysis of a North American database. The equation is as follows:

RTS = (0.9368 * GCS Value) + (0.7326 * SBP Value) + (0.2908 * RR Value)

RTS interpretation and survival probability

Values of RTS may range from 0 to 7.8408. The lower the value of RTS, the poorer the prognosis is for the patient. Patients with RTS value of 4 and less should be treated in trauma centers. The survival probability correlates with RTS value.

RTS value	0	1	2	3	4	5	6	7	7.8408
Survival probability	2.7%	7.1%	17.2%	36.1%	60.5%	80.7%	91.9%	96.9%	98.8%

Let's get an example!

A patient after a serious car accident is unconscious, GCS 5 pts, SBP 80mmHg, RR 30/min. To estimate his RTS, you can calculate it with the formula above. Patient receives 1 GCS value point, 3 SBP value points and 3 RR value points, so the equation looks like this:

RTS = (0.9368 * 1) + (0.7326 * 3) + (0.2908 * 3)

RTS = 4.007

This result means that:

The patient has about 60.5% chance of survival;
He should probably be treated in the trauma center.

Łukasz Białek, MD