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Printed on 6/29/2026
For informational purposes only. This is not medical advice.
The Revised Trauma Score (RTS) is a physiologic scoring system used for trauma triage and outcome prediction. It uses three coded parameters: Glasgow Coma Scale (GCS), systolic blood pressure (SBP), and respiratory rate (RR), each converted to a 0–4 coded value, then weighted: RTS = 0.9368 × GCS(c) + 0.7326 × SBP(c) + 0.2908 × RR(c). The maximum score is 7.8408. RTS is used in the field by paramedics for triage decisions and in trauma registries for quality assessment. It is also a key component of the TRISS methodology for predicting trauma survival. Formally assess consciousness with [Glasgow Coma Scale](/tools/glasgow-coma-scale). Monitor hemodynamic compromise with [Shock Index](/tools/shock-index) and [MAP Calculator](/tools/map-calculator). For ICU patients, quantify organ dysfunction with [SOFA Score](/tools/sofa-score) and [APACHE II](/tools/apache-ii).
Formula: RTS = 0.9368 × GCS(coded) + 0.7326 × SBP(coded) + 0.2908 × RR(coded). Max = 7.8408.
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Convert each vital sign to a coded value: RR (breaths/min): 10–29=4, >29=3, 6–9=2, 1–5=1, 0=0. SBP (mmHg): >89=4, 76–89=3, 50–75=2, 1–49=1, 0=0. GCS: 13–15=4, 9–12=3, 6–8=2, 4–5=1, 3=0. Note: For mass casualty incident (MCI) field triage, use the unweighted Triage RTS (T-RTS = RR code + SBP code + GCS code, max 12) — simpler and faster than the weighted formula.
Multiply each coded value by its weight and sum: RTS = 0.9368 × GCS(coded) + 0.7326 × SBP(coded) + 0.2908 × RR(coded). Maximum possible score = 7.8408 (all three coded values = 4). The GCS component has the highest weight, reflecting consciousness as the strongest physiological predictor of trauma outcome.
RTS 7.84 = physiologically normal, no urgency for trauma center unless mechanism or injury pattern warrants. RTS <7.84 = at least one parameter compromised, consider trauma center. RTS <4 = severe physiological derangement, high mortality, immediate care. Any RTS <7.84 is Step 2 physiologic criteria in the CDC Field Triage Decision Scheme for trauma center transport. Combine with mechanism (Step 1) and anatomy (Step 3) criteria for complete triage.
Paramedics, disaster response teams, EMS command
In mass casualty incidents, use the unweighted Triage RTS (T-RTS = RR code + SBP code + GCS code, max 12) rather than the complex weighted formula. T-RTS <11 suggests need for immediate care. More commonly, START (Simple Triage and Rapid Treatment) triage is used for MCIs — it assesses breathing, perfusion, and mental status without any mathematical calculation, making it faster under field conditions.
Paramedics, emergency medical technicians
Paramedics use RTS as part of the CDC Field Triage Decision Scheme to determine appropriate transport destination (trauma center vs community hospital). RTS <7.84 at scene meets physiological Step 2 criteria for trauma center transport. Document RTS in the patient care report (PCR) and communicate to the receiving trauma team during pre-alert.
Trauma registry staff, quality improvement officers
RTS is a required data element in most trauma registry systems (NTDB, state trauma registries). Standardized RTS documentation enables multi-center outcome comparison, quality benchmarking, and epidemiological research. RTS at scene and on arrival are both collected. Combined with ISS (Injury Severity Score) and age in the TRISS model, RTS enables survival probability prediction for quality review.
Trauma surgeons, trauma program managers, researchers
TRISS (Trauma and Injury Severity Score) combines RTS, ISS, age, and injury type (blunt vs penetrating) to calculate probability of survival (Ps). Ps = 1 / (1 + e^(-b)) where b is a linear combination of RTS, ISS, and age. Ps <50% defines a 'major trauma' patient. Compare actual vs predicted survival (unexpected survivors and deaths) to measure trauma center quality. TRISS is the gold standard for trauma benchmarking.
Emergency physicians, trauma surgeons, hospital trauma teams
RTS <7.84 is Step 2 of the ACS/CDC Field Triage Decision Scheme criteria. At the trauma center, abnormal RTS parameters (GCS ≤13, SBP <90, RR <10 or >29) automatically trigger full trauma team activation in most protocols. Document time of first vital signs to track Golden Hour compliance — definitive trauma care within 60 minutes improves outcomes.
Trauma surgeons, neurosurgeons, emergency physicians
The GCS component of RTS provides a rapid TBI severity classification: GCS 13–15 = mild TBI; GCS 9–12 = moderate TBI; GCS ≤8 = severe TBI requiring airway protection and neurosurgical consultation. A patient with RTS <4 due to severe TBI (GCS coded 0–1) requires immediate CT head, neurosurgical assessment, and ICP monitoring consideration. Use [Glasgow Coma Scale](/tools/glasgow-coma-scale) for full neurological scoring.
The weighted RTS formula requires decimal multiplication under stressful field conditions and is impractical for MCI triage. Use the unweighted Triage RTS: T-RTS = RR code + SBP code + GCS code (max 12). T-RTS <11 identifies patients needing immediate trauma center care. T-RTS 12 = walking wounded (delayed care). T-RTS 0 = deceased/expectant. Most field triage now uses START triage, which is even simpler.
Alcohol and drug intoxication can depress GCS by 2–4 points without underlying TBI. An intoxicated trauma patient with GCS 11 (coded 3, not 4) has a lower RTS than their actual physiological status warrants. Document suspected intoxication and re-assess GCS after sobriety when clinically appropriate. For triage purposes, always use the measured GCS, not an estimated sober GCS.
An SBP coded 3 or lower (SBP ≤89 mmHg) indicates trauma-associated hypotension. This is an independent trigger for hemorrhage control: tourniquet application for extremity bleeding, pelvic binder for suspected pelvic fracture, and massive transfusion protocol activation. Do not wait for full RTS calculation when a hypotensive trauma patient needs immediate intervention.
Elderly patients have reduced physiological reserve and may have impaired tachycardic and vasoconstrictor responses to hemorrhage. An elderly patient with SBP 95 and HR 80 (SI = 0.84) may be in significant shock despite relatively preserved vital signs. For elderly trauma patients, lower your threshold for trauma center activation — an RTS that looks acceptable may still represent significant injury.
The 'Golden Hour' in trauma care refers to the period during which definitive surgical hemorrhage control, airway management, and resuscitation most significantly impact survival. RTS helps prioritize patients requiring immediate transfer to trauma centers. Time from injury to definitive care (OR or ICU) should be tracked and minimized. Field triage decisions based on RTS directly impact Golden Hour compliance.
TRISS (Trauma Injury Severity Score) uses RTS + ISS + age + injury type to calculate probability of survival (Ps). Ps = 1/(1+e^(-b)). A Ps <50% identifies patients expected to die. Unexpected survivors (Ps <50% but survived) and unexpected deaths (Ps >50% but died) are quality improvement flags. Monthly review of unexpected outcomes identifies trauma center performance gaps.
Full trauma team activation criteria include: GCS ≤13, RR <10 or >29, SBP <90 mmHg, penetrating injury to torso/neck/head, extremity amputation, two or more long bone fractures, suspected spinal cord injury, burns >15% TBSA, or MCI designation. RTS criteria overlap with these but mechanism and anatomy criteria (Step 1 and Step 3 of CDC Field Triage) can override a physiologically normal RTS.
Revised Trauma Score published by Champion et al. (J Trauma 1989). Original Champion Trauma Score simplified to RTS with logistic regression-derived coefficients. TRISS methodology (Boyd et al., J Trauma 1987) combines RTS and ISS for survival probability prediction. C-statistic for mortality ~0.87. START triage system (Benson et al., Ann Emerg Med 1996) used more commonly for MCI. ATLS 10th edition references RTS for trauma patient assessment documentation.
The Revised Trauma Score ranges from 0 to 7.8408, with higher scores indicating better physiologic status. A maximum score of 7.84 (all coded values equal to 4) indicates normal GCS, systolic blood pressure, and respiratory rate. Any score below 7.84 means at least one physiologic parameter is compromised. An RTS between 4 and 7.84 indicates moderate physiologic derangement, while an RTS below 4 indicates severe injury with high mortality risk.
The RTS correlates directly with survival probability. An RTS of 7.84 is associated with survival rates above 97%, while an RTS of 4 corresponds to approximately 60% survival, and an RTS of 0 carries near-zero survival probability. These probabilities are further refined when the RTS is combined with the Injury Severity Score (ISS) in the TRISS methodology.
Any score below the maximum should prompt consideration of transport to a designated trauma center, as per the American College of Surgeons field triage guidelines. The weighted scoring emphasizes GCS (consciousness) as the strongest predictor of outcome, followed by blood pressure, with respiratory rate contributing the least weight.
Use the Revised Trauma Score in the prehospital setting for field triage decisions — specifically to determine whether a trauma patient needs to be transported to a Level I or Level II trauma center rather than the nearest hospital. Paramedics and first responders can calculate it rapidly using only three readily available vital signs. An RTS below 7.84 is one of the Step 2 physiologic criteria in the CDC Field Triage Decision Scheme.
The RTS is also used in hospital trauma registries for quality assurance and benchmarking. As part of the TRISS methodology (combining RTS with ISS and patient age), it enables comparison of actual versus expected survival across institutions. Researchers use it in trauma epidemiology studies to standardize injury severity reporting.
The RTS has important limitations in certain patient populations. It may overestimate injury severity in patients who are intoxicated (artificially lowered GCS), intubated and sedated (altered GCS and RR), or on beta-blockers or other medications that blunt physiologic responses. Conversely, it may underestimate severity in young, fit patients who can maintain normal vitals despite significant hemorrhage until sudden decompensation.
The coded scoring system creates broad categories that lose granularity. For example, a GCS of 13 and a GCS of 15 both receive a coded value of 4, despite meaningful clinical differences. Similarly, the SBP category treats all values above 89 mmHg equally, missing the prognostic difference between an SBP of 90 and 140.
The RTS does not incorporate mechanism of injury, anatomic injury pattern, or patient comorbidities, all of which significantly affect outcomes. It should be used as one component of a comprehensive triage assessment, not as a sole decision-making tool. Pediatric patients require age-adjusted vital sign parameters that the standard RTS does not provide.
For related assessments, see Glasgow Coma Scale, Shock Index and APACHE II Score.
Disclaimer: This tool is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about your health.
April 21, 2026 · trust-baseline
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