The BIG Score and Prediction of Mortality in Pediatric Blunt Trauma

• Published in: The Journal of pediatrics Vol. 167; no. 3; pp. 593 - 598.e1
• Main Authors: Davis, Adrienne L., MD, FRCPC, Wales, Paul W., MD, MSc, FRCSC, Malik, Tahira, BS, Stephens, Derek, MSc, Razik, Fathima, MD, Schuh, Suzanne, MD, FRCPC
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2015
• Subjects: Adolescent; Child; Child, Preschool; Emergency Service, Hospital; Female; Hospital Mortality; Humans; Infant; Intensive Care Units, Pediatric - statistics & numerical data; Male; Pediatrics; Probability; Retrospective Studies; Risk Factors; ROC Curve; Trauma Severity Indices; Wounds, Nonpenetrating - complications; Wounds, Nonpenetrating - mortality; BD; Injury Severity score; ROC; ISS; INR; Intensive care unit; Emergency department; Receiver operating characteristic; Base deficit; Glasgow Coma Scale; GCS; International normalized ratio; ICU; ED
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2015.05.041

Objectives To examine the association between in-hospital mortality and the BIG (composed of the base deficit [B], International normalized ratio [I], Glasgow Coma Scale [G]) score measured on arrival to the emergency department in pediatric blunt trauma patients, adjusted for pre-hospital intubation, volume administration, and presence of hypotension and head injury. We also examined the association between the BIG score and mortality in patients requiring admission to the intensive care unit (ICU). Study design A retrospective 2001-2012 trauma database review of patients with blunt trauma ≤17 years old with an Injury Severity score ≥12. Charts were reviewed for in-hospital mortality, components of the BIG score upon arrival to the emergency department, prehospital intubation, crystalloids ≥20 mL/kg, presence of hypotension, head injury, and disposition. Results 50/621 (8%) of the study patients died. Independent mortality predictors were the BIG score (OR 11, 95% CI 6-25), prior fluid bolus (OR 3, 95% CI 1.3-9), and prior intubation (OR 8, 95% CI 2-40). The area under the receiver operating characteristic curve was 0.95 (CI 0.93-0.98), with the optimal BIG cutoff of 16. With BIG <16, death rate was 3/496 (0.006, 95% CI 0.001-0.007) vs 47/125 (0.38, 95% CI 0.15-0.7) with BIG ≥16, ( P  < .0001). In patients requiring admission to the ICU, the BIG score remained predictive of mortality (OR 14.3, 95% CI 7.3-32, P  < .0001). Conclusions The BIG score accurately predicts mortality in a population of North American pediatric patients with blunt trauma independent of pre-hospital interventions, presence of head injury, and hypotension, and identifies children with a high probability of survival (BIG <16). The BIG score is also associated with mortality in pediatric patients with trauma requiring admission to the ICU.