Calculate the Revised Trauma Score (RTS) for trauma triage and prognostication. Uses GCS, systolic BP, and respiratory rate for field and hospital assessment.
The Revised Trauma Score (RTS) is one of the most widely used physiological trauma scoring systems for prehospital triage and hospital prognostication. Developed by Champion et al. in 1989, it distills the patient's physiological response to injury into a single score based on three variables: Glasgow Coma Scale (GCS), systolic blood pressure (SBP), and respiratory rate (RR).
The triage RTS (T-RTS) ranges from 0-12, with each parameter coded 0-4. The weighted RTS (used in TRISS probability calculation) applies different coefficients to each parameter, reflecting the relative prognostic importance of neurological status (highest weight), hemodynamic status (moderate weight), and respiratory function (lowest weight).
RTS is a critical component of trauma system activation: a triage RTS <12 is Step 1 in the CDC Field Triage Decision Scheme for transport to a designated trauma center. It is also essential for quality improvement and outcome benchmarking when combined with the Injury Severity Score (ISS) in the TRISS methodology.
Rapid physiological assessment is essential in trauma for two decisions: (1) Where should this patient go? (field triage — local hospital vs. trauma center) and (2) What is the expected outcome? (prognostication and quality benchmarking). The RTS answers both questions using three measurements available in seconds.
The weighted RTS component of TRISS has been the international standard for trauma outcome prediction for over 30 years, allowing hospitals to compare observed vs. expected mortality for quality improvement.
Triage RTS = GCS coded (0-4) + SBP coded (0-4) + RR coded (0-4) Range: 0-12 Coding: GCS 13-15→4, 9-12→3, 6-8→2, 4-5→1, 3→0 SBP >89→4, 76-89→3, 50-75→2, 1-49→1, 0→0 RR 10-29→4, >29→3, 6-9→2, 1-5→1, 0→0 Weighted RTS = 0.9368 × GCS + 0.7326 × SBP + 0.2908 × RR
Result: RTS 10 — Survival ~60%, Moderate trauma
GCS 10 (coded 3) + SBP 85 (coded 3) + RR 24 (coded 4) = triage RTS 10. This patient has an RTS <12, meeting CDC field triage criteria for transport to a trauma center. The moderate score suggests a roughly 60% survival probability, warranting aggressive resuscitation and rapid evaluation.
The CDC recommends a 4-step triage process: Step 1 — Physiological criteria (RTS <12, GCS <14). Step 2 — Anatomical criteria (penetrating injuries, flail chest, amputation, skull fracture). Step 3 — Mechanism of injury (high-energy mechanism, ejection, pedestrian struck). Step 4 — Special considerations (age >55, anticoagulant use, pregnancy, burns). Meeting criteria at any step triggers transport to a trauma center.
The Major Trauma Outcome Study (MTOS) established TRISS norms for expected survival. Hospitals compare their actual outcomes to TRISS-predicted outcomes using the W-statistic (excess survivors per 100 patients). A positive W means the hospital performs better than expected; negative W indicates worse than expected. This methodology drives trauma center verification and continuous quality improvement.
The Pediatric Trauma Score (PTS) is often used alongside or instead of RTS for children. PTS includes weight, airway, consciousness, SBP, fractures, and wounds. PTS ≤8 suggests transport to a pediatric trauma center. RTS can be used for pediatric patients, but normal vital sign ranges differ by age.
Triage RTS is the simple sum (0-12) used for field triage decisions. Weighted RTS applies coefficients reflecting each parameter's prognostic importance: GCS (0.9368) > SBP (0.7326) > RR (0.2908). The weighted RTS (range 0-7.84) feeds into the TRISS survival probability formula along with the Injury Severity Score.
TRISS (Trauma and Injury Severity Score) combines the weighted RTS (physiological) with the Injury Severity Score (anatomical) and patient age to calculate probability of survival: Ps = 1/(1+e^(-b)), where b = b0 + b1×RTS + b2×ISS + b3×Age. It is the international standard for trauma outcome prediction and quality benchmarking.
Both. The field RTS (at the scene or first assessment) is used for triage decisions. The admission RTS (first hospital measurement) is used for prognostication and TRISS. The two may differ significantly if prehospital interventions (intubation, fluids) alter vital signs between field and hospital.
Yes. RTS is purely physiological and can be normal (12) in patients with severe anatomical injuries (solid organ lacerations, aortic dissection) who have not yet decompensated. This is why the CDC triage scheme uses RTS as only Step 1, followed by anatomical assessment (Step 2) and mechanism of injury (Step 3).
If the patient is intubated and sedated/paralyzed, GCS cannot be assessed accurately. Some protocols assign a default GCS of 3 for intubated patients (worst case), others estimate the pre-intubation GCS, and others use the verbal component as NT1 (not testable). This can significantly affect the RTS and should be documented.
In mass casualty incidents (MCI), RTS guides START/SALT triage systems. RTS 12: Minor (Green). RTS 11: Delayed (Yellow). RTS 4-10: Immediate (Red). RTS <4: Expectant (Black — unlikely to survive with available resources). This differs from individual patient triage where all patients receive maximal care.