Revised Trauma Score and Transport Decisions

The Revised Trauma Score (RTS) is an advanced scoring system used to quickly assess the severity of a trauma patient's condition and determine the appropriate level of care needed. It is designed to identify patients who should be directed to a trauma center, ensuring they receive the specialized care required for their injuries. The RTS is calculated based on a patient's initial assessment, providing valuable information that can be communicated efficiently in time-sensitive situations.

The RTS is calculated using three critical values from the patient's presentation during the initial assessment:

1. Glasgow Coma Scale (GCS): This scale measures a patient's level of consciousness based on eye, verbal, and motor responses. It is an essential indicator of neurological function and potential head injury severity.
2. Systolic Blood Pressure (SBP): This value reflects the patient's cardiovascular status and the ability to maintain adequate perfusion. Low blood pressure may indicate shock, blood loss, or severe injury.
3. Respiratory Rate (RR): This measure assesses the patient's ability to breathe effectively and maintain oxygenation. Abnormal respiratory rates can signal respiratory distress, brain injury, or other severe trauma.

Scoring the RTS

Each of the three components is assigned a score that contributes to the overall RTS. Here’s how the scoring works for each parameter:

1. Glasgow Coma Scale (GCS) Points:

   • GCS 13-15 = 4 points
   • GCS 9-12 = 3 points
   • GCS 6-8 = 2 points
   • GCS 4-5 = 1 point
   • GCS 3 = 0 points

2. Systolic Blood Pressure (SBP) Points:

   • SBP > 89 mmHg = 4 points
   • SBP 76-89 mmHg = 3 points
   • SBP 50-75 mmHg = 2 points
   • SBP 1-49 mmHg = 1 point
   • SBP 0 mmHg = 0 points

3. Respiratory Rate (RR) Points:

   • RR 10-29 breaths per minute = 4 points
   • RR > 29 breaths per minute = 3 points
   • RR 6-9 breaths per minute = 2 points
   • RR 1-5 breaths per minute = 1 point
   • RR 0 breaths per minute = 0 points

Interpreting the RTS

The RTS values range from 0 to 7.8408. The GCS score carries the most weight in the calculation, followed by systolic blood pressure and respiratory rate. This weighted approach reflects the importance of neurological status in trauma assessment. Generally, a lower RTS score indicates a more severe injury and a higher risk of mortality.

• RTS < 4: A score below 4 typically indicates critical injuries that require immediate transport to a trauma center equipped with specialized resources.
• RTS ≥ 4: Scores of 4 and above suggest less severe trauma, but patients should still be monitored closely for any signs of deterioration. Transport decisions may vary based on specific clinical findings and available local resources.

Key Pearls of Wisdom:

1. Lower Scores Indicate Greater Severity: A lower RTS score correlates with a higher likelihood of severe trauma and a need for immediate, specialized care.
2. RTS is a Guide, Not an Absolute: The RTS is a valuable tool, but it should not replace clinical judgment. When making decisions, consider the patient's overall presentation, medical history, and other clinical findings.
3. Use of RTS in Field Triage: Utilize the RTS during the initial assessment to help determine the urgency of care and appropriate transport destination. It can aid in prioritizing patients at the scene of a multiple casualty incident (MCI).
4. Air Transport for Severe Cases: For patients with low RTS scores or those at risk of rapid deterioration, consider air medical transport to minimize transport time and deliver advanced care as quickly as possible.
5. Adherence to Local Protocols: Always follow local protocols and guidelines when determining transport destinations. Familiarize yourself with the resources available at nearby facilities, including trauma centers, children’s hospitals, and other specialized care units.

Practical Application of the RTS

1. Communication Efficiency: The RTS provides a standardized way for emergency responders, hospital staff, and receiving facilities to communicate patient severity. This common language helps ensure that the patient receives timely and appropriate care.
2. Decision-Making in the Field: Using the RTS helps EMS providers decide which patients need to be transported to a Level I trauma center versus those who can be stabilized and monitored in less specialized settings.
3. Importance of Initial Assessment: The RTS is based on the initial assessment. Early identification of critical trauma patients can improve outcomes by facilitating faster access to necessary interventions.

Trauma Centers and Transport Decisions

Trauma centers are classified into five levels, with Level I centers offering the most comprehensive care, including around-the-clock access to specialists, surgeons, and advanced diagnostic capabilities.

• Level I Trauma Center: For patients with the most severe and life-threatening injuries.
• Level II-III Trauma Centers: Capable of handling serious injuries, with some limitations compared to Level I centers.
• Level IV-V Trauma Centers: Provide basic emergency care and stabilization before transferring patients to higher-level trauma centers if needed.