Introduction to Injury
Scoring Systems
Part 1- Physiologic Scores
Amado Alejandro Báez MD MSc
About the Author
• Dr. Amado Alejandro Báez MD MSc
initiated his involvement with trauma and
injuries while working as an Emergency
medical Services provider in Santo
Domingo Dominican Republic in the early
1990’s. After graduating from medical
school at the Universidad Nacional Pedro
Henriquez Ureña, he furthered his studies
with graduate education in Emergency
medical services, Public health and
Clinical Research.
Learning Objectives
• To understand the basic principles of
injury scoring.
• To review the principal physiological
injury scoring systems.
• The review basic r applications of
these systems.
Performance Objectives
• At the end of this module to participant
will be able to:
• Apply basic principles of injury scoring
in clinical and research scenarios.
• Understand literature containing injury
scoring systems.
Introduction
• Scoring systems used in Trauma can
be classified into:
– Physiologic such as the Trauma
Score, and Glasgow Coma Scale.
– Anatomical such as the Abbreviated
Injury Scale and the Injury Severity
Score
– Combined score such as the TRISS
method and ASCOT
PHYSIOLOGIC SCORES
• The Revised Trauma Score (RTS)
• Glasgow Coma Scale (GCS)
• The Acute Physiology and Chronic
Health Evaluation (APACHE)
Glasgow Coma Score
• The Glasgow Coma Scale (GCS) is
the standard measure used to
quantify level of consciousness in
head injured patients.
• Widely used in scoring systems,
treatment protocols and general
clinical decision-making in critically
ill patients.
Teasdale G., Jennett B., LANCET (ii) 81-83, 1974.
Glasgow Coma Score
• The GCS is scored between 3 and 15, 3
being the worst, and 15 the best.
• GCS is composed of three parameters :
Best Eye Response, Best Verbal
Response, Best Motor Response.
• A GCS of 13 or higher correlates with a
mild brain injury, 9 to 12 is a moderate
injury and 8 or less a severe brain injury.
Glasgow Coma Score
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Best Eye Response. (4)
No eye opening =>1
Eye opening to pain =>2
Eye opening to verbal command =>3
Eyes open spontaneously =>4
Glasgow Coma Score
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Best Motor Response. (6)
No motor response =>1
Extension to pain=>2
Flexion to pain=>3
Withdrawal from pain=>4
Localizing pain=>5
Obeys Commands=>6
Glasgow Coma Score
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Best Verbal Response. (5)
No verbal response =>1
Incomprehensible sounds =>2
Inappropriate words =>3
Confused =>4
Orientated =>5
The Revised Trauma Score
RTS utilizes 3 physiologic parameters:
–Glasgow Coma Scale (GCS)
–Systemic blood pressure (SBP)
–Respiratory rate (RR)
• The RTS has been used in the out-ofhospital setting as a tool for trauma center
triage.
• The RTS has also been used as a
prognostic tool for survival.
The Revised Trauma Score
Two types of RTS:
1.Triage RTS: Determined by adding each
of the coded values together.
2.The coded form of the RTS is more
frequently used for quality assurance
and outcome prediction. The coded RTS
is calculated as follows:
RTSc = 0.7326 SBPc + 0.2908 RRc + 0 .9368
GCSc
The Revised Trauma Score
Glasgow
Systolic Blood Respiratory
Coma Scale
Pressure
Rate
(GCS)
(SBP)
(RR)
RTS
Value
13-15
>89
10-29
4
9-12
76-89
>29
3
6-8
50-75
6-9
2
4-5
1-49
1-5
1
3
0
0
0
The Acute Physiology and
Chronic Health Evaluation
• APACHE has two components:
1.The chronic health evaluation,
which incorporates the influence
of comorbid conditions (such as
diabetes and cirrhosis)
2.Acute Physiology Score (APS).
The Acute Physiology and
Chronic Health Evaluation
• The APS consists of weighted
variables representing the major
physiologic systems, including
neurological, cardiovascular,
respiratory, renal, gastrointestinal,
metabolic, and hematological
variables.
Web Based Resources
• http://www.cdc.gov/ncipc/
CDC’s The National Center for Injury
Prevention and Control (NCIPC)
• http://www.carcrash.org/
Association for the Advancement of
Automotive Medicine. An international
multidisciplinary organization for
crash injury control
• http://www.injurycontrol.com/icrin/
Injury Control Resource Information
Network
Web Based Resources
• http://www.jhsph.edu/Research/Centers/CIRP/
The Johns Hopkins Center for Injury
Research & Policy
• http://www.trauma.org
A British web-based trauma resource
center
• http://www.trauma.org/scores/rtscalc.html
Revised Trauma Score Calculator from
trauma.org