Riki Ristanto, Amin Zakaria, Heny Nurmayunita


Measurement of severity and mortality predictions in cases of head injury is an important step to support appropriate, effective and efficient clinical decision-making. Glasgow Coma Score, Trauma Score, and Revised Trauma Score are physiologycal scoring systems that can be used as predictors of mortality of head injury patients. The objective of the study was to know which scoring systems had the best accuracy as a predictor of mortality of head injured patients. The observational analytic study with this retrospective cohort design approach was carried out at dr. Iskak Tulungagung on Medical Record. Data taken from all patient medical records from January 2016 to July 2017 amounted to 150 medical records. Variables used were GCS, RTS, and TS scores when patients were admitted to hospital IGD as well as patient mortality data within 7 days of treatment. The data obtained is then processed with SPSS 20 using Mann Whitney Test, logistic regression and ROC curve comparison. Based on the results of multivariate logistic regression analysis, GCS accuracy results: sensitivity= 0.7586, specificity= 0.7934, PPV= 0.468, NPV= 0.932; RTS accuracy: sensitivity= 0.766, specificity= 0.8, PPV= 0.489, and NPV= 0.932; TS accuracy: sensitivity= 0.7, specificity= 0.783, PPV= 0.4468, NPV= 0.9126. The comparison graph analysis of ROC curve showed no significant difference of AUC between GCS, RTS, and TS because the difference was too low (<15%). There was no significant difference of accuracy between RTS, GCS, and TS use in predicting head injury mortality.
Keywords: Mortality, Head Injury Patient, RTS, GCS, TS.


Keywords: Mortality, Head Injury Patient, RTS, GCS, TS.

Full Text:



Amanda, Gita & Marbun, Julkifli. (2014). Indonesia Urutan Pertama Peningkatan Kecelakaan Lalu Lintas. http// Diakses tanggal 24 Juli 2016 Pukul 09.11 WIB.

Arikunto, S. (2010). Prosedur Penelitian Suatu Pendekatan Praktik Edisi Revisi. Jakarta: Rineka Cipta.

Badan Penelitian dan Pengembangan Kesehatan Departemen Kesehatan RI. (2008). Laporan Nasional : Riset Kesehatan Dasar 2007. Jakarta, Departemen Kesehatan RI.

Badan Statistik Nasional.(2013).Statistik Transportasi 2013.Jakarta: Badan Pusat Statistik BPS – Statistics Indonesia, p 32-35.

Baroto, R. T. (2007). Pengaruh Koagulopati Terhadap Glaslow OutCome Score Pada Penderita Cidera Kepala Berat dengan Gambaran CT Scan. Difusse Injury. Semarang, Universitas Diponegoro.

Bonne, S., & Schuerer, D. (2013). Trauma in the Older Adult: Epidemiology and Evolving Geriatric Trauma Principles. Clin Geriatric Med, 29, 137-150

Bouzat, Pierre, Legrand, Robin, Gillois, Pierre, Ageron, François-Xavier, Brun, Julien, Savary, Dominique, Payen, Jean-François. (2015). Prediction of intra-hospital mortality after severe trauma: which pre-hospital score is the most accurate? Injury. doi:

Brazinova, A., Mauritz, W., Leitgeb, J., Wilbacher, I., Janciak, I. (2010). Outcome of Patients With Severe Traumatic Brain Injury Who Have Glasglow Coma Score Scores of 3 or 4 and Are Over 65 years Old. Neurotrauma. 27(9): 1549-55.

Bullock, M. R., Povlishock. (2007). Guidline For The Management Of Severe Traumatic Brain Injury. Journal Neurotrauma. 24 (5).

Campbell, Jhon. (2012). International Trauma Life Support For Emergency Care Provider. Alabama, American: American College Emergency Phycisian. 7th Edition. America, American College Emergency Physcian. ISBN-13: 978-0-13-215724-7.

CDC. (2009). Traumatic Brain Injury: Statistics. Atlanta: CDC.

Champion, H. R. (1981). Final report quantitation of injury and critical illness. National Center for Health Services Research Grant. No. HS-02559.

Champion, H. R., Sacco, W. J., Copes, W. S., Gann, D. S., Gennarelli, T. A., Flanagan, M. E. (1989). A revision of the trauma score. J Trauma. 29:623–9.

Colantonio, A., Saverino, C., Zagorski, B. (2010). Hospitalizations and emergency department visits for TBI in Ontario. Can J Neurol Sci. 37: 783–790.

Coronado, V., Xu, L., Basavaraju, S., McGuire, L., Wald, M., Faul, M., . . . Hemphill, J. (2011). Surveillance for Traumatic Brain Injury--Related Deaths --- United States, 1997--2007. Centers for Disease Control and Prevention, 60, 1-32.

Dahlan, S. (2013). Statistik Untuk Kedokteran Dan Kesehatan. Ed. 5. Jakarta: Salemba Medika.

Dahlan, S. (2014). Statistik Untuk Kedokteran Dan Kesehatan. Seri 1. Ed. 6. Jakarta: Salemba Medika.

Edna, T. H. (1983). Risk faktor in traumatic head injury. Acta Neurochir. 69: 15-21.

Eichelberger, Martin R., Gotschall, Catherine S., Sacco, William J., Bowman, Leon M., Antonio Mangubat, E., & Lowenstein, Adam D. (1989). A comparison of the trauma score, the revised trauma score, and the pediatric trauma score. Annals of Emergency Medicine, 18(10), 1053-1058. doi:

Faul, Mark, & Coronado, Victor. (2015). Chapter 1 - Epidemiology of traumatic brain injury. In G. Jordan & M. S. Andres (Eds.), Handbook of Clinical Neurology (Vol. Volume 127, pp. 3-13): Elsevier.

Grace, P.A. Borley, N.R., (2008). At Glance Ilmu Bedah. Jakarta, Erlangga.

Haddad, S. H. & Arabi, Y. M. (2012). Critical care Management of Severe Traumatic Brain Injury in Adults. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 20 (12): 1-15. doi: 10.1186/1757-7241-20-12.

Irawan, H., Setiawan, F., Dewi, Dewanto G. (2010). Perbandingan glasgow coma Score dan revised trauma score dalam memprediksi disabilitas pasien trauma kepala di RS. Atma Jaya. Majalah Kedokteran Indonesia. Vol. 60. No. 10.

Jennet, B. (2005). Development of Glasgow Coma and Outcome Score. Nepal Journal of Neuroscience. 2 (1) : 24-28.

Kartikawati, Dewi. (2012). Dasar-dasar Keperawatan Gawat Darurat. Jakarta: Salemba Medika.

Kenneth, J. Rhee, Neil, H.W., James, E.T., Richard, E.W. (1987). Trauma Score Change During Transport: Is It Predictive of Mortality?. American Journal of Emergency Medicine. Vol. 5 (5): 353-356.

Kondo, Y., Abe, T., Kohshi, K., Tokuda, Y., Cook, E.F. and Kukita, I. (2011). Revised trauma scoring system to predict In hospital mortality in the emergency department: Glasgow Coma Score, Age, and systolic blood pressure score. Critical Care, 15: R191.

Kowalski, Robert E. (2010). Terapi hipertensi: program 8 minggu menurunkan tekanan darah tinggi dan mengurangi resiko serangan jantung dan stroke secara alami. Bandung: Qanita

Kung, Woon-Man, Tsai, Shin-Han, Chiu, Wen-Ta, Hung, Kuo-Sheng, Wang, Shin-Ping, Lin, Jia-Wei, & Lin, Muh-Shi. (2011). Correlation between Glasgow coma score components and survival in patients with traumatic brain injury. Injury, 42(9), 940-944. doi:

Laytin, Adam D., Kumar, Vineet, Juillard, Catherine J., Sarang, Bhakti, Lashoher, Angela, Roy, Nobhojit, & Dicker, Rochelle A. (2015). Choice of injury scoring system in low- and middle-income countries: Lessons from Mumbai. Injury, 46(12), 2491-2497. doi:

Lee, John C., Rittenhouse, Katelyn, Bupp, Katherine, Gross, Brian, Rogers, Amelia, Rogers, Frederick B., . . . Thurmond, James. (2015). An analysis of Brain Trauma Foundation traumatic brain injury guideline compliance and patient outcome. Injury, 46(5), 854-858. doi:

Li Y., Zhang L., Wang Yi., & Zhang, Wei. (2013). The flatness index of inferior vena cava is udeful in predicting hypovolemic shock in severe multiple-injury patients. The Journal of Emergency Medicine, Vol. 45, No. 6, pp. 872-878, 2013. DOI: 10.1016/j.jemermed.2013.04.036.

Lichtveld, R., Spijkers, A., Hoogendoorn, J., Panhuizen, L., & Werken, C. (2008). Triage revised trauma score with mortality rate traumatic patients within the first 24 hours of hospitalization. Journal Res Med Sci, 16(11), 33.

Lingsma, H., Rozzenbeek, B., Steyerberg, E., Murray, G., & Maas, A. (2014). Early prognosis in traumatic brain injury: from prophecies to predictions. Lancet Neurol, 9, 543. doi: 10.1016/S1474-4422(10)70065-X

Madikian, A., Giza, C., (2006). A Clinician’s Guide to The Pathophysiology of Trauma Brain Injury. Indian Journal of Neurotrauma (IJNT). 3(1). 9-11

Mahdian, M., Fazel, M.R., Fakharian, E., Akbari, H., Mahdian, S. (2014). “Cerebral State Index Versus Glaslow coma Score As A predictor for In Hospital Mortality in Brain Injured Patients.” Chinese Journal of Traumatologi. 17(4): 220-224.

Manley, T. G., Rosenfeld, V. J., Maas, I. A., Bragge, P., Morganti-Kossman, M. C., Gruen, L. R. (2012). Early Management of Severe Traumatic Brain Injury. Journal of The Lancet. 380 (9847):1088-98. doi: org/10.1016/S0140-6736(12)60864-2.

Musofa, Zain. (2015). Hingga September 2015, Ada 23 Ribu Kasus Kecelakaan Di Indonesia. http// Diakses tanggal 24 Juli 2016 Pukul 09.06 WIB.

Muttaqin, A. (2008). Pengantar asuhan keperawatan klien dengan gangguan sistem persyarafan. Jakarta: Salemba Medika

Newberry, Criddle. (2000). Trauma Nursing Care Course. Ed. 5. Des Plaines III. The Association.

Newgard, D. C., Meier, N. E, Bulger, M. E., Buick, J., Sheehan, K., Lin, S., Minei, P. J., Barner, M. A., Roxy, B. K. The ROC Investigator. (2015). Revisiting the Golden Hour : An Evaluation of Out of Hospital Time in Shock and Traumatic Brain Injury. Journal Annals of Emergency Medicine. 66(1). PP : 30-41.e1. doi : 10.1016/j.annemergmed.2014.12.004.

Notoatmodjo, S. (2010). Metodologi Penelitian Kesehatan. PT. Rineka Cipta. Jakarta.

Oertel, M., Kelly, DF., Lee, JH., McArthur, DL., Glenn, TC., Vespa, P. (2002). Efficacy of hyperventilation, blood pressure elevation, and metabolic suppression theraphy in controlling intracranial pressure after head injury. J Neurosurg. 97: 1045-1053.

Oyetunji, T., Crompton, J.G., Efron, D.T., Haut, E.R., Chang, D.C., Cornwell, E.E., Baker, S,P., and Haider, A.H. (2010). Simplifying Physiologic Injury Severity Measurement for predicting trauma outcomes. Journal Of Surgical Research. 159, 627 – 632.

Perry & Potter. (2005). Fundamental keperawatan: konsep, proses, dan praktik. Jakarta: EGC.

Poon, W.S., Zhu, X.L., Ng, SCP., Wong, GKC. (2005). Predicting one year clinical outcome in traumatic brain injury (TBI) at the beginning of rehabilitation. Acta Neurochir. 93:207-8.

Rahmawati, Ika. (2013). Analisis Faktor-Faktor Yang Berhubungan Dengan Nilai Revised Trauma Score Dalam Memprediksi Mortality Pasien Cedera Kepala Berat Di RSD. Mardi Waluyo Blitar. Tesis. Universitas Brawijaya.

Rapsang, A. G., & Shyam, D. C. (2015). Scoring Systems of Severity in Patients with Multiple Trauma. Cirugía Española (English Edition), 93(4), 213-221. doi:

Rayvita. (2010). Mean Arterial Pressure Post Resusitasi Sebagai Prediktor Keluaran Pasien Cedera Otak Traumatik Berat Dengan Gambaran CT Scan Cedera Difus. Undergraduate Thesis. Fakulty Of Medicine Universitas Indonesia.

Rogert, H., Gerber, L., Lacono, L., Ni, Q., Lyons, K., Ghajar, J. (2006). Direct Transport Within An Organized State Trauma System Reduces Mortality in Patients With Severe Traumatic Brain Injury. Journal of Trauma-Injury Infection & Critical Care: Original Articles. 6(60): 1250-1256. doi: 10.1097/01.ta.0000203717.57821.8d.

Roorda, J., van Beeck, E. F., Stapert, J. W. J. L., & ten Wolde, W. (1996). Evaluating performance of the Revised Trauma Score as a triage instrument in the prehospital setting. Injury, 27(3), 163-167. doi:

Rosenfeld, V. J., Maas, I. A., Bragge, P., Morganti, K. M. C., Manley, T. G., Gruen, L. R. (2012). Early Management of Severe Traumatic Brain Injury. Journal of The Lancet. 380 (9847):1088-98. doi: org/10.1016/S0140-6736(12):60864-2.

Rosjidi, C.H., Nurhidayat, S. (2009). Buku Ajar Perawatan Cidera Kepala dan Stroke. Yogyakarta: Ardana Media.

Ryan. (2009).Caring for patient with traumatic brain injuries; are you up to the challenge?. American Nurse Today, 4 (8).

Safrizal, S., Bachtiar, H. (2013). Hubungan nilai oxygen delivery dengan outcome rawatan pasien cedera kepala sedang. Bagian Ilmu Bedah Fakultas Kedokteran. Padang: Universitas Andalas.

Salim, Carolina. (2015). Sistem penilaian trauma. CDK-232/ vol. 42 no. 9, th. 2015

Sastrodiningrat, A. G. (2006). Memahami Faktor-Faktor yang Mempengaruhi Prognosa Cedera Kepala Berat. Majalah Kedokteran Nusantara. 39(3).

Senkowski, C. K., McKenney, M.G. (1999). Trauma scoring systems : A Review. J Am Coll Surg. 30: 540.

Sharf, M.S., El-Gebali, M.A. (2013). Correlation between glasgow coma Score and jugular venous oxygen saturation in severe traumatic brain injury. Egyptian Journal of Anaesthesia. 29, 267-272.

Signorini, D. F., Andrews, P. J., Jones, P. A. (1999). Predicting survival using simple clinical case study in traumatic brain injury. Journal Neuoral Neurosurg Psychitry. 60: 20-25.

Smith, J., & Roberts, R. (2011). Vital signs for nurses an introduction to clinical observations. London: Wiley-Blackwell.

Soertidewi, L. (2012). Penatalaksanaan Kedaruratan Cedera Kranioserebral. Jakarta: FKUI.

Streubert & Carpenter. (2003). Qualitative Research in Nursing Advancing The Humanistic Imperative. Philadelpia. Lipincott.

Ting, Hsien-Wei, Chen, Ming-Shung, Hsieh, Yueh-Chun, & Chan, Chien-Lung. (2010). Good Mortality Prediction by Glasgow Coma Score for Neurosurgical Patients. Journal of the Chinese Medical Association, 73(3), 139-143. doi:

Tjahjadi, M., Arifin, M. Z., Gill, A. S., & Faried, A. (2013). Early mortality predictor of severe traumatic brain injury: A single center study of prognostic variables based on admission characteristics. The Indian Journal of Neurotrauma, 10(1), 3-8. doi:

Tsao, J., & Moore, D.(2010).Traumatic brain injury a clinician’s guide to diagnosis, management, and rehabilitation. Anaesthesia and Intensive Care Medicine, 15 (4); 164.

Warfield, C.A., Bajwa, Z.H. (2004). Principles and practice of pain medicine. 2nd ed. US: McGraw-Hill.

Werner, C., & Engelhard. (2007). Pathophysiology of traumatic brain injury. British Journal of Anaesthesia, 99(1), 4-9. doi: 10.1093/bja/aem131.

Wilkinson, I., Lennox, G. (2005). Essential neurology. 4th ed. Oxford: Blackwell Publishing.

Yu, A., Cheng, H., Xu, L., Basavaraju, S., Tsao, L.(2010). Functional outcome after head injury comparison of 12-45 year old male and female. International Journal Care Injury. 43; 603-607.

Yulius, T. (2010). Gangguan Asam-Basa Karena Hipertermia Pada Cedera Kepala. Anestesia & Critical Care. 28 (3): 38-43

Zafonte, R.D., Hammond, F.M., Mann, N.R., Wood, D.L., Millis, S.R., Black, K.L. (1996). Revised trauma score: an additive predictor of disability following traumatic brain injury?. Am J Phys Med Rehabil. 75:456-61.


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.