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Admission base deficit in pediatric trauma: a study using the National Trauma Data Bank
E H Kincaid1, M C Chang, R W Letton
1Department of General Surgery and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
Insights
Admission base deficit is a key indicator of injury severity and mortality risk in pediatric trauma patients. A base deficit less than -8 mEq/L signals potentially lethal injuries in children.
Area of Science:
- Pediatric Trauma Care
- Critical Care Medicine
- Emergency Medicine
Background:
- Base deficit is a known indicator of physiologic derangement in adult trauma.
- Its predictive value in pediatric trauma has not been well-established.
Purpose of the Study:
- To assess the ability of admission base deficit to predict injury severity and outcomes in pediatric trauma patients.
Main Methods:
- Analysis of 515 pediatric patients (0-12 years) from the National Trauma Data Bank.
- Examined base deficit, age, and severe closed head injury in relation to mortality and injury severity indicators.
Main Results:
- Base deficit < -4 mEq/L and closed head injury predicted mortality.
- An admission base deficit of -8 mEq/L correlated with a 25% mortality probability.
- Base deficit correlated significantly with systolic blood pressure, Injury Severity Score, and Revised Trauma Score.
Conclusions:
- Admission base deficit effectively reflects injury severity and predicts mortality in pediatric trauma.
- A base deficit < -8 mEq/L in children warrants clinical alert for potentially lethal conditions or shock.
Background:
The base deficit, an important indicator of physiologic derangement after severe injury in adults, has not been specifically examined in the pediatric trauma population. The purpose of this study was to assess the ability of the admission base deficit to predict injury severity and outcome in the pediatric trauma population.
Methods:
The study group included all patients in the National Trauma Data Bank over a 2-year period aged 0 to 12 years with a base deficit (0 to -30 mEq/L) recorded from the emergency department. Age, presence of a severe closed head injury, and base deficit were analyzed with respect to mortality and other indicators of injury severity.
Results:
A total of 515 patients constituted the study group. Base deficit less than -4 mEq/L (p < 0.001) and the presence of a closed head injury (odds ratio, 3.8; p < 0.05) were predictors of mortality. For the group, an admission base deficit of -8 mEq/L corresponded to a probability of mortality of 25%. Significant correlations were found between base deficit and emergency department systolic blood pressure, Injury Severity Score, and Revised Trauma Score. There was no relationship between age and mortality.
Conclusion:
In injured children, the admission base deficit reflects injury severity and predicts mortality. The probability of mortality increases precipitously in children with a base deficit less than -8 mEq/L, and should alert the clinician to the presence of potentially lethal injuries or uncompensated shock.
