Simplifying physiologic injury severity measurement for predicting trauma outcomes.

Document Type


Publication Date



DOI: 10.1016/j.jss.2009.08.026


BACKGROUND: The Revised Trauma Score (RTS) is commonly used to assess physiologic injury; however its use is limited by missing data. This study compares different parameters of physiologic injury assessment in their ability to predict mortality after trauma.

METHODS: Adult patients in the National Trauma Data Bank (NTDB version 7.0) were analyzed, and the following physiologic injury parameters were compared: RTS, systolic blood pressure (SBP), shock (SBP

RESULTS: There were 1,484,648 patients who met inclusion criteria. In unadjusted analyses, RTS had the highest proportion of missing data (21%) and was highly predictive of mortality (AUROC = 0.85). SBP and shock had a much lower AUROC of 0.67 and 0.66, respectively, but had many fewer missing cases. The combination parameters of GCS-M with SBP or GCS-M with shock showed AUROC comparable to RTS (0.85) with approximately 80,000 fewer missing cases.

CONCLUSION: The discriminatory power of RTS is significantly better than SBP, shock, or GCS alone. Given the limitation of missing data associated with RTS, the combination of SBP and GCS-M is a more reliable and equally effective method of assessing physiologic injury severity in studying trauma outcomes.

Journal Title

The Journal of surgical research





First Page


Last Page


MeSH Keywords

Adult; Glasgow Coma Scale; Humans; Motor Activity; Patient Selection; Reproducibility of Results; Systole; Trauma Severity Indices; Traumatology; Treatment Outcome


Coma Scale; Trauma Score; Outcomes; Death; National Trauma Data Bank; NTDB

Library Record COinS