What is the Revised Trauma Score?
The Revised Trauma Score (RTS) is a physiologic scoring system developed by Champion et al. in 1989 for use in trauma care. It assesses three parameters that reflect the most critical physiological functions: neurological status (Glasgow Coma Scale), cardiovascular status (systolic blood pressure), and respiratory status (respiratory rate).
The RTS exists in two versions: the weighted RTS used for outcome prediction and quality assurance (using coefficients derived from regression analysis), and the unweighted Triage-RTS (T-RTS) used for field triage decisions (simple sum of coded values). Higher scores indicate better prognosis, with a maximum possible score of 7.8408.
Coded Value Tables
Glasgow Coma Scale Coding
| GCS Score | Coded Value |
|---|---|
| 13–15 | 4 |
| 9–12 | 3 |
| 6–8 | 2 |
| 4–5 | 1 |
| 3 | 0 |
Systolic Blood Pressure Coding
| SBP (mmHg) | Coded Value |
|---|---|
| > 89 | 4 |
| 76–89 | 3 |
| 50–75 | 2 |
| 1–49 | 1 |
| 0 | 0 |
Respiratory Rate Coding
| RR (breaths/min) | Coded Value |
|---|---|
| 10–29 | 4 |
| > 29 | 3 |
| 6–9 | 2 |
| 1–5 | 1 |
| 0 | 0 |
RTS Formula
The weighted RTS is calculated using regression coefficients that reflect the relative importance of each parameter in predicting survival:
The maximum possible RTS is:
The Triage-RTS (T-RTS) is simply the unweighted sum:
RTS Survival Curve Diagram
Survival Probability Table
| RTS Score | Estimated Survival | Severity |
|---|---|---|
| 7.84 (maximum) | 99% | Minimal |
| 7 | 97% | Minimal |
| 6 | 90% | Moderate |
| 5 | 80% | Serious |
| 4 | 60% | Severe |
| 3 | 36% | Critical |
| 2 | 29% | Critical |
| 1 | 25% | Critical |
| 0 | 4% | Unsurvivable |
T-RTS & Field Triage
The Triage-RTS (T-RTS) is the unweighted version used for rapid field assessment. A T-RTS < 12 (i.e., any coded value less than 4) is a widely used criterion for transport to a Level I or Level II trauma center.
| T-RTS Score | Triage Decision |
|---|---|
| 12 | Minor trauma; local facility may be appropriate |
| 11 | Consider trauma center transport |
| 3–10 | Transport to trauma center; higher acuity |
| 1–2 | Transport to trauma center; critical |
| 0 | Expectant / unsalvageable in mass casualty situations |
TRISS Methodology
The Revised Trauma Score is a key component of the TRISS (Trauma and Injury Severity Score) methodology, which combines:
- RTS (physiologic assessment)
- ISS (Injury Severity Score — anatomic assessment)
- Patient age (dichotomized at age 55)
- Mechanism (blunt vs. penetrating)
TRISS provides the most comprehensive survival prediction and is the standard method used by the American College of Surgeons for trauma outcome evaluation.
Worked Example
A trauma patient presents with: GCS = 10, Systolic BP = 80 mmHg, Respiratory Rate = 32 breaths/min
| Parameter | Value | Coded Value |
|---|---|---|
| GCS | 10 | 3 (range 9–12) |
| SBP | 80 mmHg | 3 (range 76–89) |
| RR | 32/min | 3 (range >29) |
With an RTS of approximately 5.88, the estimated survival probability is around 88%. The T-RTS of 9 (< 12) indicates this patient should be transported to a designated trauma center.
Frequently Asked Questions
Why is GCS weighted most heavily in the RTS?
The coefficient for GCS (0.9368) is the highest because neurological status has been shown to be the strongest single predictor of trauma outcome. Brain injury severity, as reflected by GCS, has the most significant impact on mortality. Blood pressure and respiratory rate, while important, have slightly less predictive power individually.
What is the difference between RTS and T-RTS?
The RTS uses weighted coefficients for precise outcome prediction and quality assurance. The T-RTS is the simple unweighted sum (range 0–12) designed for rapid field use by paramedics and first responders. Both use the same coded values but apply them differently: RTS multiplies each by a regression coefficient, while T-RTS simply adds them.
Can the RTS be used for intubated patients?
For intubated patients, the respiratory rate component should be based on the ventilator rate if the patient has no spontaneous respirations. The GCS verbal component is typically assigned the lowest score (1) with a notation "T" for intubated. Some trauma registries use modified scoring for intubated patients.
How does the RTS fit into trauma system evaluation?
The MTOS (Major Trauma Outcome Study) used RTS as part of the TRISS methodology to benchmark trauma center performance. By comparing actual outcomes against TRISS-predicted outcomes (using the W-statistic), trauma systems can identify patients who unexpectedly survived or died, facilitating quality improvement and peer review.
Is the RTS still relevant in modern trauma care?
Yes. Despite being developed in 1989, the RTS remains widely used in trauma systems worldwide. While newer scoring systems exist (e.g., MGAP, GAP), the RTS maintains its role because it is well-validated across large populations, simple to calculate, and embedded in the widely used TRISS methodology. Most trauma registries continue to collect and report RTS data.