Introduction to Injury

Scoring Systems
Part 1- Physiologic Scores
Amado Alejandro Bez MD MSc
About the Author
Dr. Amado Alejandro Bez 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
1990s. After graduating from medical
school at the Universidad Nacional Pedro
Henriquez Urea, 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
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
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
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-of-
hospital 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
0
0 0 3
1
1-5 1-49 4-5
2
6-9 50-75 6-8
3
>29 76-89 9-12
4
10-29 >89 13-15

RTS
Value
Respiratory
Rate
(RR)
Systolic Blood
Pressure
(SBP)
Glasgow
Coma Scale
(GCS)



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/
CDCs 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