Trauma Triage and Scoring Systems
Definition
Trauma triage is the process of assessing and categorizing injured patients based on the severity of their condition to ensure optimal resource utilization and survival outcomes.
Types of Trauma Triage
1. Prehospital Triage (Field Triage)
• Conducted by paramedics/first responders at the scene.
• Determines whether the patient should be transported to a trauma center or a local hospital.
• Uses standardized guidelines like CDC Field Triage Guidelines.
2. Hospital Triage (Emergency Department Triage)
• Prioritizes patients upon arrival at the emergency department.
• Ensures life-threatening injuries are managed first using structured protocols.
Levels of Trauma Triage
1. Primary Triage
• Performed at the scene.
• Rapid ABCDE assessment (Airway, Breathing, Circulation, Disability, Exposure).
• Goal: Identify immediate life threats and transport the patient accordingly.
2. Secondary Triage
• Conducted in the emergency department or ICU.
• Involves detailed assessment and injury scoring.
• Helps decide definitive care (ICU, OR, ward admission).
2. Trauma Scoring Systems
Trauma scoring systems help quantify injury severity and predict patient outcomes by assessing physiological, anatomical, and biochemical parameters.
(A) Physiological Scoring Systems
1. Glasgow Coma Scale (GCS)
• Assesses neurological function based on eye, verbal, and motor responses.
|
GCS Score |
Severity of Brain Injury |
|
13 – 15 |
Mild brain injury |
|
9 – 12 |
Moderate brain injury |
|
≤ 8 |
Severe brain injury (coma, intubation needed) |
2. Revised Trauma Score (RTS)
Used in prehospital and emergency settings for rapid trauma assessment.
|
Parameter |
RTS Score |
|
GCS |
0-4 |
|
Systolic BP (mmHg) |
0-4 |
|
Respiratory Rate (breaths/min) |
0-4 |
• RTS < 4 → Poor prognosis, requires immediate intervention.
3. Shock Index (SI)
- Shock Index (SI) is a rapid bedside tool used to assess hemodynamic stability and detect early shock. It is calculated as:
Shock Index=Heart Rate (HR) divided by Systolic Blood Pressure (SBP)
|
Shock Index (SI) |
Clinical Interpretation |
|
< 0.5 |
May indicate bradycardia or high BP |
|
0.5 – 0.7 |
Normal, stable hemodynamics |
|
0.7 – 0.9 |
Early compensation, monitor closely |
|
0.9 – 1.0 |
Occult shock, risk of decompensation |
|
> 1.0 |
High risk of shock, immediate intervention needed |
|
> 1.3 |
Severe shock, mortality risk increased |
(B) Anatomical Scoring Systems
1. Abbreviated Injury Scale (AIS)
• Scores injury severity for each organ system.
• Scale: 1 (minor) to 6 (unsurvivable).
2. Injury Severity Score (ISS)
• Sum of squares of the three most severely injured regions (AIS).
• ISS > 15 → Major trauma requiring ICU care.
3. New Injury Severity Score (NISS)
• Modifies ISS by using three highest AIS scores, even if in the same region.
• More accurate for penetrating injuries.
(C) Composite Scoring Systems
1. Trauma and Injury Severity Score (TRISS)
• Predicts mortality risk using RTS, ISS, and patient age.
• Used to compare trauma center performance.
2. Pediatric Trauma Score (PTS)
• Used in children < 16 years.
• Score < 8 → Major trauma, requires trauma center.
MCQs (Multiple Choice Questions)
1. Which triage system is used in prehospital trauma assessment?
A) Revised Trauma Score (RTS)
B) APACHE II
C) SOFA Score
D) ASA Classification
Answer: A) Revised Trauma Score (RTS)
2. What is the cutoff ISS for defining major trauma?
A) 10
B) 15
C) 20
D) 25
Answer: B) 15
3. What is the most important predictor of airway compromise in trauma?
A) ISS score
B) GCS < 8
C) RTS score
D) NISS score
Answer: B) GCS < 8
4. Which physiological parameter is NOT part of the Revised Trauma Score?
A) GCS
B) Systolic BP
C) Heart Rate
D) Respiratory Rate
Answer: C) Heart Rate
5. A trauma patient with HR 120 bpm and BP 80/50 mmHg has a Shock Index of:
A) 0.5
B) 0.75
C) 1.5
D) 2.0
Answer: C) 1.5