Revista do Colégio Brasileiro de Cirurgiões
http://www.rcbc.periodikos.com.br/article/doi/10.1590/0100-6991e-2026005925
Revista do Colégio Brasileiro de Cirurgiões
Artigo Original

O papel do Escore do Trauma Revisado (RTS) em trauma penetrante

The role of the Revised Trauma Score in penetrating trauma

Steffany Barbosa Reis; Matheus Portugal; Maria Tavares; Malu Adan; Gabriel Santana; Ana Romeo

http://dx.doi.org/10.1590/0100-6991e-2026005925 RCBC, vol.53, e2026005925, 2026
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Resumo

Introdução: O Revised Trauma Score (RTS) é amplamente utilizado como ferramenta prognóstica no trauma, porém sua acurácia em lesões penetrantes permanece controversa. Considerando que esse mecanismo representa parcela significativa dos atendimentos no Brasil, torna-se essencial avaliar o desempenho do escore nessas populações.

Objetivo: Comparar a acurácia prognóstica do RTS para predição de mortalidade entre vítimas de trauma contuso e penetrante, além de identificar um ponto de corte equivalente para indicação de transferência a centros de Trauma nível I.

Materiais e Métodos: Trata-se de um estudo de coorte retrospectiva com pacientes atendidos entre 2015 e 2019 em um hospital de referência em Trauma. Foram analisados dados clínicos, laboratoriais e fisiológicos, com cálculo do RTS. A acurácia foi avaliada por curvas ROC e comparada pelo teste de DeLong. Regressão logística identificou preditores independentes de mortalidade.

Resultados: Foram incluídos 3575 pacientes, 68,5% vítimas de trauma contuso e 31,5% de penetrante. A AUC do RTS foi de 0,813 para trauma contuso e 0,800 para penetrante (p=0,67). Lesões penetrantes aumentaram em 61% o risco de mortalidade. A equivalência entre mecanismos mostrou que um RTS ≤4,99 no trauma contuso corresponde a um RTS ≤6,99 no penetrante.

Conclusão: O RTS apresenta acurácia semelhante para ambos os mecanismos de trauma. Entretanto, vítimas de trauma penetrante apresentam maior mortalidade, sugerindo a necessidade de ponto de corte mais elevado para triagem e transferência.

Palavras-chave

Valor Preditivo dos Testes; Ferimentos Penetrantes; Índices de Gravidade do Trauma

Abstract

Introduction: The Revised Trauma Score (RTS) is one of the primary tools used to predict mortality in trauma patients. RTS is calculated at admission based on respiratory rate, systolic blood pressure, and Glasgow Coma Scale score. Its accuracy has been evaluated in several studies; however, most have predominantly included victims of blunt trauma, making its applicability to penetrating injuries a matter of ongoing debate.

Objective: To compare the prognostic accuracy of the RTS for mortality prediction in patients with blunt trauma versus penetrating trauma.

Methods: This retrospective cohort study included trauma patients treated at a referral hospital. The prognostic accuracy of the RTS for each trauma mechanism was assessed using receiver operating characteristic curves, and comparisons were performed using the DeLong test. Logistic regression analysis was conducted to identify additional independent predictors of trauma mortality. The chi-square test was used to determine a cutoff point for the RTS in penetrating trauma that would correspond to the reference cutoff adopted for blunt trauma.

Results: A total of 3,575 patients were included. Of these, 2,448 (68.5%) sustained blunt trauma and 1,127 (31.5%) penetrating trauma. The area under the curve for mortality prediction was 0.813 in the blunt trauma group and 0.800 in the penetrating trauma group, with no statistically significant difference between them. Independent predictors of mortality included age, RTS value, acidosis, coagulopathy, and penetrating mechanism.

Conclusion: The RTS is an accurate tool for predicting mortality in both blunt trauma and penetrating trauma.

Keywords

Predictive Value of Tests; Wounds, Penetrating; Trauma Severity Indices

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Submetido em:
11/12/2025

Aceito em:
02/02/2026

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