Revised trauma score: an additive predictor of disability following traumatic brain injury?

Recent studies have clarified the role of hypoxic-ischemic damage as a secondary factor in traumatic brain injury (TBI). Many trauma centers are now consistently using the Revised Trauma Score (Glasgow Coma Scale, systolic blood pressure, and respiratory rate) to assist with triage of multitrauma patients. This study investigated the predictive power of the Revised Trauma Score (RTS) instead of the Glasgow Coma Scale (GCS) in determination of disability as measured by the Disability Rating Scale (DRS). Data were obtained as part of the National Institute for Disability and Rehabilitation Research TBI Model Systems database on 501 patients receiving acute medical care and inpatient rehabilitation within a coordinated neurotrauma program for treatment of TBI. Initial RTS and GCS were obtained on admission to the emergency department, along with the lowest GCS measured in the first 24 h. Analysis of initial RTS and GCS demonstrated modest, but statistically significant Pearson's correlations with DRS at rehabilitation admission (-0.18 and -0.25, respectively) and discharge (-0.22 and -0.24, respectively). Lowest GCS within the first 24 h postinjury also failed to show a strong relationship with DRS at rehabilitation admission (-0.28) and discharge (-0.24). Multiple regression analysis performed on RTS subsets for systolic blood pressure and respiratory rate did not reveal an added predictive value. Although RTS may be important in emergency triage for its ability to predict mortality, this study indicates its limited usefulness in prediction of disability.