Revised Trauma Score Calculator

About the Revised Trauma Score Calculator

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.

When This Page Helps

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.

How to Use the Inputs

1. Assess Glasgow Coma Scale (3-15) and select the coded value.
2. Measure systolic blood pressure and select the coded range.
3. Count respiratory rate and select the coded range.
4. Review the triage RTS (sum of coded values, range 0-12).
5. Score <12: consider transport to a Level I/II Trauma Center.
6. The weighted RTS is automatically calculated for TRISS use.
7. Combine with ISS for TRISS survival probability (requires additional data).

Example Calculation

Tips & Best Practices

• RTS = 12 does not mean "no significant injury" — it means physiologically stable. Always assess anatomy and mechanism.
• Prehospital intubation changes the GCS component — document pre-intubation GCS when possible.
• In elderly patients, SBP >89 may still represent shock (they may be normally hypertensive).
• Respiratory rate >29 is given a lower coded value (3) than 10-29 (4), capturing tachypnea as abnormal.
• A single-point drop in coded GCS (e.g., 4→3) changes triage RTS by 1 but weighted RTS by 0.94.
• Combine RTS with mechanism of injury for comprehensive triage — neither alone is sufficient.

CDC Field Triage Decision Scheme

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.

TRISS and Quality Improvement

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.

Pediatric Considerations

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.

Frequently Asked Questions

• What is the difference between triage RTS and weighted RTS?

  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.

• What is TRISS?

  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.

• Should RTS be calculated in the field or hospital?

  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.

• Can RTS miss severe injuries?

  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).

• How does intubation affect the GCS component?

  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.

• What is the role of RTS in mass casualty triage?

  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.