Revised Trauma Score (RTS)
GCS Score coded (0–4)
Systolic BP coded (0–4)
Respiratory Rate coded (0–4)
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.
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.
- 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.
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.
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.
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.
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.
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
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
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
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
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
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
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.
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.
Penetrating Head Injury
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.
| 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 |
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.
What are the limitations of the RTS?
RTS only captures physiology at a single time point and misses anatomical injury burden. It does not account for mechanism, age, or comorbidities independently. It can be normal in significant anatomical injury (e.g., splenic laceration without haemodynamic compromise). GCS component is affected by alcohol, sedation, and pre-existing conditions. This is particularly important in the context of trauma score calculations, where accuracy directly impacts decision-making. Professionals across multiple industries rely on precise trauma score computations to validate assumptions, optimize processes, and ensure compliance with applicable standards. Understanding the underlying methodology helps users interpret results correctly and identify when additional analysis may be warranted.
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.
What RTS value triggers major trauma centre activation?
An RTS below 4 is the traditional threshold for major trauma. In triage settings, T-RTS below 12 (i.e., any coding below 4 in any parameter) triggers immediate transport to a major trauma centre. Local trauma protocols vary; many centres use RTS alongside other criteria (mechanism, anatomy, special patient groups). This is particularly important in the context of trauma score calculations, where accuracy directly impacts decision-making. Professionals across multiple industries rely on precise trauma score computations to validate assumptions, optimize processes, and ensure compliance with applicable standards. Understanding the underlying methodology helps users interpret results correctly and identify when additional analysis may be warranted.
How does RTS perform in penetrating versus blunt trauma?
TRISS uses different regression coefficients for blunt versus penetrating trauma because the relationship between physiology, anatomy, and survival differs. Penetrating trauma patients can deteriorate very rapidly with initially preserved physiology, making physiological scores less predictive at the time of first assessment. This is particularly important in the context of trauma score calculations, where accuracy directly impacts decision-making. Professionals across multiple industries rely on precise trauma score computations to validate assumptions, optimize processes, and ensure compliance with applicable standards. Understanding the underlying methodology helps users interpret results correctly and identify when additional analysis may be warranted.
Can the RTS be used in paediatric patients?
The RTS is less validated in children. The Paediatric Trauma Score (PTS) and TRISS paediatric adaptations are preferred. GCS component is unreliable in young children without age-specific modification. Systolic blood pressure norms differ significantly by age in children, affecting SBP coding accuracy. This is particularly important in the context of trauma score calculations, where accuracy directly impacts decision-making. Professionals across multiple industries rely on precise trauma score computations to validate assumptions, optimize processes, and ensure compliance with applicable standards. Understanding the underlying methodology helps users interpret results correctly and identify when additional analysis may be warranted.
Pro Tip
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.
Did you know?
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.