INJURY SEVERITY SCORING
Part II: Trauma Score
Robert W. Stein, III, RN, MSHA, CHE, LNC
With the advent of the trauma center system, a need developed for a method of
determining rapidly which clients were in need of transport to the nearest hospital Emergency Department, and which
required transport to the nearest Trauma Center. The method required speed and simplicity, using only basic assessment
skills. Several methods of rating, scoring, or indexing had been developed dating back to the early 1970's. Each
had its' difficulties - too complex, too time consuming, or requiring advanced assessment skills not always available
in the field. Howard Champion, MD modified existing methods and developed the Trauma Score.1 Part II of this three-part series on injury
severity scoring will discuss Champion's Trauma Score.
The Trauma Score uses the variables of respiratory rate, respiratory expansion, systolic blood pressure, capillary
refill, and the Glasgow Coma Scale. Parameters for each of the variables are assigned points. When the points are
totaled, a Trauma Score (see figure 1) of 1-16 is obtained with 1 being the most impaired and 16 being the most
stable.1
|
Trauma Score
|
Value
|
Points
|
Score
|
A. Respiratory Rate:
Number of respirations in 15 sec. multiply by four |
10-24
|
4
|
A._____
|
|
25-35
|
3
|
|
> 35
|
2
|
|
<10
|
1
|
|
0
|
0
|
| |
B. Respiratory effort:
Shallow - markedly decreased chest movement or air exchange
Retractive - use of accessory muscles or intercostal retraction |
Normal
|
1
|
B._____
|
|
Shallow, or retractive
|
0
|
| |
C. Systolic blood pressure:
Systolic cuff pressures - either arm-auscultate or palpate.
No carotid pulse. |
> 90
|
4
|
C._____
|
|
70-90
|
3
|
|
50-69
|
2
|
|
<50
|
1
|
|
0
|
0
|
| |
D. Capillary Refill:
Normal-forehead, lip mucosa or nail bed color refill in 2 sec.
Delayed-more than 2 sec, of capillary refill.
None-no capillary refill |
Normal
|
2
|
D._____
|
|
Delayed
|
1
|
|
None
|
0
|
| |
| E. Glasgow coma scale Total GCS Points: |
14-15
|
5
|
E._____
|
|
11-13
|
4
|
|
8-10
|
3
|
|
5-7
|
2
|
|
3-4
|
1
|
| |
Trauma Score:
(Total points A+B+C+D+E) |
TS=_____
|
| Figure 1: Example of Trauma Score worksheet. |
For the variable of respiratory rate, four points are awarded for rates of 10-24,
three points for rates of 24-35, two points for rates greater than 36/mm, and one point for rates 1-9/mm. No points
area awarded for the apneic or non-breathing patient. The variable of respiratory expansion may be either normal
(1 point), or shallow / retractive (no point) awarded.1
Four points are given with systolic blood pressures of 9Omm Hg or greater, three points for pressures of 70-9Omm
Hg, two points are awarded for pressures of 50-7Omm Hg, and one point given for pressures of 0-5Omm Hg. No points
awarded for the pulseless victim.1
In the variable of capillary refill, two points are awarded for normal refill, delayed refill receives one point.
No points are awarded when there is no capillary refill present.1
The final variable is the Glasgow Coma Scale score discussed in Part I of this three-part series. Five Trauma Score
points are awarded to Glasgow Coma Scale scores of 14-15. Four Trauma Score points are awarded to Glasgow Coma
Scale scores of 11-13. Glasgow Coma Scale scores of 8-10 receive three Trauma Score points. Two Trauma Score points
are given with Glasgow Coma Scale scores of 5-7, and one Trauma Score point is earned with Glasgow Coma Scale score
of 3-4.1
Champion also included a table of probability of survival for each of the possible 16 Trauma Scores (see figure
2). Nearly 9O% of all trauma victims will have Trauma Scores greater than 12. The probability of survival in this
group is very high exceeding 90% to nearly 100% with a Trauma Score of 16. It is the remaining 10% of patients
that trauma centers were developed to treat. The critical Trauma Score is 12, where the probability of survival
drops significantly to 83%. Scores of 12 or less serve as guides for emergency service personnel for direct referral
to the nearest Trauma Center.1
|
Trauma
Score
|
Probability of
Survival
|
Percentage of
Trauma Patients
|
|
16
|
99%
|
66%
|
|
15
|
98%
|
14%
|
|
14
|
95%
|
6.3%
|
|
13
|
91%
|
3.4%
|
|
12
|
83%
|
2.8%
|
|
11
|
71%
|
1.3%
|
|
10
|
55%
|
1.6%
|
|
9
|
37%
|
0.49%
|
|
8
|
22%
|
0.24%
|
|
7
|
12%
|
0.24%
|
|
6
|
7%
|
0.49%
|
|
5
|
4%
|
0.0%
|
|
4
|
2%
|
0.12%
|
|
3
|
1%
|
0%
|
|
2
|
0%
|
3.2%
|
|
1
|
0%
|
0%
|
| Figure 2: Probability of survival and the percentage of patients for each value
of the Trauma Score. |
REFERENCES
1. Champion, Howard. (1981), "Trauma Score". Critical Care Medicine, 9(9), 672-676. The Williams &
Wilkins Company.
