ABSTRACT

Head injury is a major consequence of traffic accidents and significantly contributes to global morbidity and mortality. Rapid and accurate initial assessment is essential for predicting clinical outcomes, especially in emergency departments. The Revised Trauma Score (RTS) and Rapid Emergency Medicine Score (REMS) are commonly used predictive tools. To evaluate and compare the effectiveness of RTS and REMS in predicting the outcomes of head injury patients in the Emergency Department of RSUD Ulin Banjarmasin. This was an analytical observational study with a retrospective cohort approach involving data from 75 head injury patients recorded between January and December 2024. Samples were selected based on inclusion criteria: patients aged ≥19 years with complete vital signs data. AUROC and the Youden index were used to assess predictive accuracy. Most patients were aged 19–44 years (54.7%) and male (72%). The most common injury mechanism was traffic accidents (70.7%). RTS categorized 90.7% of patients as low-risk, while REMS identified 56% as high-risk. RTS showed an AUC of 0.932 (sensitivity 82.6%; specificity 100%), and REMS showed an AUC of 0.954 (sensitivity 85.5%; specificity 100%). Results indicated that both RTS and REMS were significantly associated with patient outcomes (p<0.05). RTS and REMS are effective in predicting outcomes of head injury patients; however, REMS offers slightly better predictive accuracy and may serve as a more comprehensive early evaluation tool.

Keywords: Head Injury, RTS, REMS, Patient Outcome, Trauma Score, Emergency Care.

ABSTRAK

Cedera kepala merupakan dampak utama kecelakaan lalu lintas dan berkontribusi terhadap morbiditas dan mortalitas global. Penilaian awal yang cepat dan akurat diperlukan untuk memprediksi outcome klinis, khususnya di instalasi gawat darurat. Revised Trauma Score (RTS) dan Rapid Emergency Medicine Score (REMS) merupakan instrumen prediksi yang umum digunakan. Menilai dan membandingkan efektivitas RTS dan REMS dalam memprediksi outcomepasien cedera kepala di IGD RSUD Ulin Banjarmasin. Penelitian observasional analitik dengan pendekatan kohort retrospektif menggunakan data 75 pasien cedera kepala Januari–Desember 2024. Sampel ditentukan berdasarkan kriteria inklusi usia ≥19 tahun dengan data tanda vital lengkap. Analisis AUROC dan Youden index digunakan untuk mengukur akurasi prediktif. Sebagian besar pasien berusia 19–44 tahun (54,7%) dan laki-laki (72%). Mekanisme cedera terbanyak adalah kecelakaan lalu lintas (70,7%). RTS mengkategorikan 90,7% pasien pada risiko mortalitas rendah, sedangkan REMS menunjukkan 56% berisiko tinggi. RTS memiliki AUC 0,932 (sensitivitas 82,6%; spesifisitas 100%) dan REMS AUC 0,954 (sensitivitas 85,5%; spesifisitas 100%). Hasil menunjukkan bahwa RTS dan REMS memiliki hubungan yang signifikan terhadap outcome pasien (p<0,05). RTS dan REMS efektif dalam memprediksi outcome pasien cedera kepala, namun REMS memberikan akurasi prediksi yang lebih unggul dan dapat digunakan sebagai alat evaluasi awal yang lebih komprehensif.

Kata Kunci: Cedera Kepala, RTS, REMS, Outcome Pasien, Prediksi Mortalitas, Instalasi Gawat Darurat.

Abdullah, T., Al-Rasyid, H., & Rusli, K. N. D. M. A. (2022). Perbandingan Triage Early Warning Score, National Early Warning Score, Rapid Emergency Medicine Score, Dan Modified Early Warning Score Dalam Memprediksi Tingkat Kematian Pasien Trauma Di Igd Rsud Dr. Saiful Anwar Malang. Majalah Kesehatan, 9(2).

Abebe, T., Alemu, T., & Sorato, M. M. (2024). Incidence, Risk Factors And Outcomes Of Traumatic Head Injury Among Trauma Patients Visited At The Yanet Trauma And Surgery Specialized Centre, Sidama Region, Hawassa, Ethiopia: Cohort Study. Frontiers In Neurology, 15, 1431999.

Abhilash, K. P., & Sivanandan, A. (2020). Early Management Of Trauma: The Golden hour. Current Medical Issues, 18(1), 36–39.

Alvarez, B. D., Razente, D. M., Lacerda, D. A. M., Lother, N. S., Von-Bahten, L. C., & Stahlschmidt, C. M. M. (2016). Analysis Of The Revised Trauma Score (Rts) In 200 Victims Of Different Trauma Mechanisms. Revista Do Colégio Brasileiro De Cirurgiões, 43(5), 334–340.

American Collage Of Surgeons. (2022). Resources For Optimal Careof The Injured Patient . American Collage Of Surgeons.

Aprilia, H., Keperawatan, F., Kesehatan, I., Muhammadiyah Banjarmasin, U., & Penulis, K. H. (2017). Gambaran Status Fisiologis Pasien Cedera Kepala Di Igd Rsud Ulin Banjarmasin Tahun 2016. Dinamika Kesehatan: Jurnal Kebidanan Dan Keperawatan, 8(1), 237–249.

Basak, D., Chatterjee, S., Attergrim, J., Sharma, M. R., Soni, K. D., Verma, S., Gerdinwärnberg, M., & Roy, N. (2023). Glasgow Coma Scale Compared To Other Trauma Scores In Discriminating In-Hospital Mortality Of Traumatic Brain Injury Patients Admitted To Urban Indian Hospitals: A Multicentre Prospective Cohort Study. Injury, 54(1), 93–99.

Candra Puspita, A., & Talitha Yesiana Rahmawati, S. (2024). Aktivitas Fisik Rutin Dalam Produktivitas Harian Pada Dewasa Akhir (Vol. 3, Issue 2).

Cao, Y., Forssten, M. P., Sarani, B., Montgomery, S., & Mohseni, S. (2023). Development And Validation Of An Xgboost-Algorithm-Powered Survival Model For Predicting In-Hospital Mortality Based On 545,388 Isolated Severe Traumatic Brain Injury Patients From The Tqip Database. Journal Of Personalized Medicine, 13(9).

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. Journal Of Trauma - Injury, Infection And Critical Care, 29(5), 623–629.

Dash, H. H., & Chavali, S. (2018). Management Of Traumatic Brain Injury Patients. Korean Journal Of Anesthesiology, 71(1), 12–21.

Daud, I., Retno Wulan, D., Keperawatan Dan Ilmu Kesehatan, F., & Muhammadiyah Banjarmasin, U. (2021). Efektivitas Ews Dan Rts Untuk Memprediksi Outcome Pada Pasien Cedera Kepala Di Ruang Igd Rsud Ulin Banjarmasin. Dinamika Kesehatan: Jurnal Kebidanan Dan Keperawatan, 12(2), 416–425.

Davies, M., Lawrence, T., Edwards, A., Mckay, C., Lecky, F. E., Stokes, K. A., & Williams, S. (2023). Sport-Related Major Trauma Incidence In Young People And Adults In England And Wales: A National Registry-Based Study. Injury Prevention, 30(1), 60–67.

Durantez-Fernández, C., Martín-Conty, J. L., Medina-Lozano, E., Mohedano-Moriano, A., Polonio-López, B., Maestre-Miquel, C., Viñuela, A., López-Izquierdo, R., Sánchez Bermejo, R., & Martín-Rodríguez, F. (2021). Early Detection Of Intensive Care Needs And Mortality Risk By Use Of Five Early Warning Scores In Patients With Traumatic Injuries: An Observational Study. Intensive & Critical Care Nursing, 67.

Dwi Kurniawan, W., Riduansyah, M., Mahmudah Fakultas Kesehatan, Atul, Sari Mulia, U., Pramuka No, J., Luar, P., Timur, B., & Selatan, K. (2023). Efektivitas Terapi O2 Terhadap Hemodinamik Pasien Cedera Kepala Sedang Dan Berat Di Instalasi Gawat Darurat. Jurnal Keperawatan, 15(2), 569–576.

Elshamhoot, M. M., Ibrahim, W., Metwally, M. F., & Elafifi, M. A. (2022). Evaluation Of Revised Trauma Score In Polytrauma. Journal Of Advances In Medicine And Medical Research, 224–233.

Gang, M. C., Hong, K. J., Shin, S. Do, Song, K. J., Ro, Y. S., Kim, T. H., Park, J. H., & Jeong, J. (2019). New Prehospital Scoring System For Traumatic Brain Injury To Predict Mortality And Severe Disability Using Motor Glasgow Coma Scale, Hypotension, And Hypoxia: A Nationwide Observational Study. Clinical And Experimental Emergency Medicine, 6(2), 152–159.

Garkaz, O., Rezazadeh, F., Golfiroozi, S., Paryab, S., Nasiri, S., Mehryar, H., & Ghelichi-Ghojogh, M. (2022). Predicting The 28-Day Mortality Of Non-Trauma Patients Using Rems And Raps; A Prognostic Accuracy Study. Archives Of Academic Emergency Medicine, 10(1).

Heydari, F., Majidinejad, S., Ahmadi, A., Nasr-Esfahani, M., Shayannejad, H., & Fatemi, N. (2021). A Comparison Between Modified Early Warning Score, Worthing Physiological Scoring System, National Early Warning Score, And Rapid Emergency Medicine Score In Predicting Inhospital Mortality In Multiple Trauma Patients. Archives Of Trauma Research, 10(4), 188–194.

Islam, M. A., Afreen, S., & Salek, A. A. (2020). Influence Of Concomitant Injuries On Outcome Of Traumatic Brain Injury. Bangladesh Critical Care Journal, 8(1), 24–28.

Jiang, D., Chen, T., Yuan, X., Shen, Y., & Huang, Z. (2023). Predictive Value Of The Trauma Rating Index In Age, Glasgow Coma Scale, Respiratory Rate And Systolic Blood Pressure Score (Triages) And Revised Trauma Score (Rts) For The Short-Term Mortality Of Patients With Isolated Traumatic Brain Injury: A Retrospective Study. The American Journal Of Emergency Medicine, 71, 175–181.

Kasyfi, Dr. F. A. (2025). Akurasi Rotterdam Score Sebagai Faktor Prediktor Mortalitas Pasien Cedera Kepala Yang Mejalani Operasi Di Rsup Dr. Mohammad Hoesin Palembang. Universitas Sriwijaya Rumah Sakit Dr. Mohammad Hoesin Palembang.

Lestariningsih, I., Lestariningsih, I., & Awaludin, S. (2023). Comparison Of Glasgow Coma Scale With Revised Trauma Score In Assessing The Mortality Of Head Injured. Jurnal Aisyah : Jurnal Ilmu Kesehatan, 8(1), 581–588.

Marbun, A. S., Sinuraya, E., Amila, A., & Simanjuntak, G. V. (2020). A Predictor Of Outcome Following Head Injury: A Retrospective Study. Malahayati International Journal Of Nursing And Health Science, 3(2), 81–85.

Miller, P. R., Chang, M. C., Hoth, J. J., Hildreth, A. N., Wolfe, S. Q., Gross, J. L., Martin, R. S., Carter, J. E., Meredith, J. W., & D’agostino, R. (2017). Predicting Mortality And Independence At Discharge In The Aging Traumatic Brain Injury Population Using Data Available At Admission. Journal Of The American College Of Surgeons, 224 4(4), 680–685.

Miller, R. T., Nazir, N., Mcdonald, T., & Cannon, C. M. (2017). The Modified Rapid Emergency Medicine Score: A Novel Trauma Triage Tool To Predict In-Hospital Mortality.

Moran, M. E., & Nash, J. E. (2022). Revised Trauma Scale. Statpearls.

Mulyono, D. (2020). Perbedaan Glasgow Coma Scale Dan Rapid Emergency Medicine Score Dalam Memprediksi Outcome Pasien Trauma Kepala Di Instalasi Gawat Darurat. Jurnal Kesehatan, 11(2), 215–222.

Nasser, Y., El, A., Ahmed, F., Tharwat Taha, S., Mohamed, Z., Elatiff, A., El, K., Ahmed, S., & Fattah, A. El. (2025). Modified Rapid Emergency Medicine Score As A Predictor Of Emergency Interventional Need For Trauma Patients Attending Suez Canal University Hospital. The Egyptian Journal Of Hospital Medicine, 98(1), 1086–1093.

Ningsih, F. A. (2023). Gambaran Nilai Rapid Emergency Medicine Score Pada Pasien Cedera Kepala Di Instalasi Gawat Darurat Rsud Raden Mattaher.

Olsson, T., & Lind, L. (2003). Comparison Of The Rapid Emergency Medicine Score And Apache Ii In Nonsurgical Emergency Department Patients. Academic Emergency Medicine : Official Journal Of The Society For Academic Emergency Medicine, 10(10), 1040–1048.

Padaruntung, C. S., Firdaus, R., Hidayat, A., Kemenkes, P., & Timur, K. (2023). The Correlation Between Revised Trauma Score (Rts) And Head Injury Mortality In The Emergency Room. Formosa Journal Of Science And Technology , 2(7), 1789–1802.

Patel, R., Ghag, G. S., Iyer, S., & Nandu, V. V. (2024). The Revised Trauma Score: A Better Early Predictor For Survival Of Head Trauma Patients Than The Glasgow Coma Scale-Age-Pressure Score. Journal Of Acute Care Surgery, 14(2), 52–58.

Prawira, M., Kunci, K., Kepolisian, Di, B., Lintas, L., Lintas, K. L., Satya, K., & Taira, N. (2023). Penyelesaian Kasus Kecelakaan Lalu Lintas Di Wilayah Hukum Kepolisian Resor Bangli Melalui Pelaksanaan Restitusi. Kerta Dyatmika, 21(2), 9–23.

Riskesdas. (2018). Hasil Riskesdas (Riset Kesehatan Dasar) Tahun 2018. Https://Www.Slideshare.Net/Slideshow/Hasil-Riskesdas-Riset-Kesehatan-Dasar-Tahun-2018/122949528

Sari, A. Laksmita, Inayah, L. Arofatul, & Faozi, E. (2024). Penerapan Revised Trauma Score Untuk Menilai Mortalitas Pada Pasien Trauma:Systematic Review. Healthy Tadulako Journal (Jurnal Kesehatan Tadulako), 10(3), 420–428.

Wahid, A., Mapagresuka, I., & Hafifah, I. (2019). Comparison Of National Early Warning Score (News) And Revised Trauma Score (Rts) In The Outcome Prediction Of Head Injury Patients. Journal Of Nursing Science, 187–194.

Who. (2024). Accelerate Safety Measures To Reduce Road Traffic Deaths: Who. Https://Www.Who.Int/Southeastasia/News/Detail/02-09-2024-Accelerate-Safety-Measures-To-Reduce-Road-Traffic-Deaths-Who

Wulandari, N. P., Widyaningsih, W., & Utama, J. E. P. (2023). Pemberian Oksigenasi Nrm Dan Posisi Head Up 30° Terhadap Tingkat Kesadaran Dan Hemodinamik Pada Pasien Cedera Kepala. Jurnal Ilmiah Keperawatan Sht, 18(2), 118–127.

Yin, Y., & Chou, C. A. (2023). Multi-Event Survival Analysis Through Dynamic Multi-Modal Learning For Icu Mortality Prediction. Computer Methods And Programs In Biomedicine, 235.

Yu, Z., Xu, F., & Chen, D. (2021). Predictive Value Of Modified Early Warning Score (Mews) And Revised Trauma Score (Rts) For The Short-Term Prognosis Of Emergency Trauma Patients: A Retrospective Study. Bmj Open, 11(3), E041882.

Zemaitis, M. R., Planas, J. H., & Waseem, M. (2023). Trauma Secondary survey (Sat). Statpearls Publishing.