Trauma scoring systems

Trauma Scoring Systems - The Injury Ticker

• Purpose: Objectively assess trauma severity for triage, prognostication, and research.
• Physiological (Dynamic): Reflects the patient's immediate response.
  • GCS: Glasgow Coma Scale (3-15).
  • RTS (Revised Trauma Score): Weighted sum of GCS, SBP, and RR. Guides field triage.
• Anatomical (Static): Quantifies the extent of injuries.
  • ISS (Injury Severity Score): Sum of squares of the highest AIS scores in the 3 most injured body regions. Range 1-75.

⭐ An ISS > 15 defines major trauma and is a strong predictor of mortality.

Glasgow Coma Scale (GCS) - Brain-Gauging Basics

A rapid, standardized system to assess level of consciousness, typically after traumatic brain injury.

• Total Score: Sum of the best eye, verbal, and motor responses.
  • Range: 3 (deep coma) to 15 (fully awake).
• Severity Classification:
  • Mild: 13-15
  • Moderate: 9-12
  • Severe: ≤8 (indicates need for intubation)

⭐ For intubated patients, the verbal score is non-assessable and is recorded with a "T" (e.g., GCS 10T). The motor score becomes the most critical predictor of outcome in these cases.

Revised Trauma Score (RTS) - Vitals Get Vocal

• A key physiological scoring system used in trauma settings to predict patient outcomes and guide triage decisions.
• Calculated from three primary vital signs, each assigned a coded value from 0-4.

⭐ The Triage-RTS (T-RTS) is a simpler, unweighted version used for rapid field triage. It is the sum of the coded values (range 0-12). A T-RTS < 11 suggests transport to a designated trauma center.

ISS & TRISS - Anatomy of Injury

• Injury Severity Score (ISS): A purely anatomical scoring system quantifying injury severity. It correlates with mortality, morbidity, and hospital stay.

  • Based on the Abbreviated Injury Scale (AIS), which grades injury to a single body part on a scale of 1 (minor) to 6 (unsurvivable).
  • Calculation: The ISS is the sum of the squares of the highest AIS scores in the three most severely injured body regions.
  • Formula: $ISS = (AIS_1)^2 + (AIS_2)^2 + (AIS_3)^2$
  • The maximum ISS score is 75.

• Trauma and Injury Severity Score (TRISS): Combines anatomical and physiological measures (ISS and RTS) with patient age to predict survival probability ($P_s$).

⭐ An AIS score of 6 in any region (an unsurvivable injury) automatically results in an ISS of 75, the maximum possible score.

• The Glasgow Coma Scale (GCS) is fundamental for assessing level of consciousness; a score of < 8 indicates severe injury and likely need for intubation.
• Revised Trauma Score (RTS) uses GCS, systolic blood pressure, and respiratory rate for physiological assessment and field triage.
• Injury Severity Score (ISS) is an anatomical scoring system based on the three most severe injuries, which strongly correlates with mortality.
• TRISS combines RTS, ISS, and age to calculate a probability of survival.