Revised Trauma Score (RTS)

The Revised Trauma Score (RTS) is a physiological scoring system used to assess trauma severity and predict outcomes. It evaluates three parameters—Glasgow Coma Scale, systolic blood pressure, and respiratory rate—assigning each a coded value. The simple sum (T-RTS) is used for prehospital triage, while a weighted formula improves mortality prediction in research. A lower score indicates severe trauma and higher mortality risk. It is widely used for triage, emergency assessment, and trauma research but does not account for anatomical injuries or comorbidities.

The Revised Trauma Score (RTS) is a widely used physiological scoring system designed to assess the severity of trauma and predict patient outcomes. It plays a crucial role in prehospital triage, emergency department evaluation, and trauma research.

Originally developed as a refinement of the Trauma Score, the RTS improves reliability and practicality by focusing on key physiological parameters that are rapidly measurable in emergency settings.

Components of the Revised Trauma Score

The RTS is based on three core physiological variables:

Glasgow Coma Scale (GCS)
Systolic Blood Pressure (SBP)
Respiratory Rate (RR)

These parameters reflect the neurological, circulatory, and respiratory status of the patient, respectively.

Each variable is converted into a coded value (0–4) depending on predefined ranges.

See Also: Glasgow Coma Scale (GCS)

RTS Coding System

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

RTS Calculation

There are two main forms of RTS:

1. Triage RTS (T-RTS)

Simple sum of coded values:

T-RTS = GCS code + SBP code + RR code

Maximum score = 12
Used in prehospital triage

2. Weighted RTS (for outcome prediction)

The weighted formula is:

RTS = (0.9368 × GCS) + (0.7326 × SBP) + (0.2908 × RR)

Maximum score ≈ 7.8408
Used in trauma registries and research

This weighted system improves mortality prediction accuracy compared to the original Trauma Score.

Clinical Interpretation

Higher RTS → Better prognosis
Lower RTS → Increased mortality risk

Key thresholds:

RTS < 8 (T-RTS) → Severe trauma, high risk of mortality
RTS near maximum → Mild injury

The RTS is highly effective in identifying patients who require trauma center care, correctly detecting over 97% of non-survivors in early studies.

Clinical Applications

1. Prehospital Triage

Rapid identification of critically injured patients
Helps determine transport to Level I trauma centers

2. Emergency Department Assessment

Provides objective physiological assessment
Supports early decision-making

3. Trauma Research and Quality Control

Standardized scoring system for:
- Outcome prediction
- Trauma registry data
- Comparative studies

The RTS remains a standard physiologic severity score in trauma systems worldwide.

Advantages of RTS

Simple and rapid to calculate
Uses readily available clinical data
Reliable predictor of mortality
Applicable in both prehospital and hospital settings

Limitations

Less accurate in isolated severe injuries (e.g., single-region trauma)
Does not account for:
- Anatomical injury severity
- Patient comorbidities
Requires accurate measurement of vital signs, which may be difficult in chaotic environments

Comparison with Other Trauma Scores

Score	Type	Key Use
RTS	Physiological	Triage & prognosis
Injury Severity Score (ISS)	Anatomical	Injury burden
Trauma Score (TS)	Older physiological	Replaced by RTS

The RTS complements anatomical scores like ISS for comprehensive trauma assessment.

Summary

The Revised Trauma Score (RTS) is a cornerstone tool in trauma care, integrating neurological status (GCS), blood pressure, and respiratory rate into a rapid, reproducible scoring system.

Essential for triage and early management
Strong predictor of mortality
Widely validated in trauma systems

Despite some limitations, RTS remains a fundamental component of modern trauma assessment protocols.

Revised Trauma Score Online Calculator