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Initial base deficit as predictors for mortality and transfusion requirement in the severe pediatric trauma except
Jinhee Jung1, Eunkyung Eo, Kiok Ahn
1Department of Emergency Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
Insights
The initial base deficit (BD) in pediatric trauma patients predicts mortality and transfusion needs. A BD of -8 mEq/L or less indicates significantly higher risks.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Critical Care
- Biochemical Markers in Shock
Background:
- The prognostic value of initial base deficit (BD) in pediatric trauma is not well-established.
- Adult studies indicate BD is a key indicator of shock severity.
- Pediatric trauma research needs to clarify BD's predictive role.
Purpose of the Study:
- To evaluate the initial base deficit (BD) as a predictor of mortality in pediatric trauma patients.
- To assess the initial BD's ability to predict blood transfusion requirements in children.
- To exclude patients with severe brain injuries from the analysis.
Main Methods:
- Retrospective review of 102 pediatric severe trauma patients admitted to a university hospital emergency department (1998-2005).
- Analysis of initial systolic blood pressure, base deficit (BD), and Injury Severity Score.
- Multiple regression analysis to identify independent predictors of mortality and blood transfusion needs.
Main Results:
- Initial base deficit (BD) was an independent predictor of mortality (OR 13.6 for BD ≤ -8 mEq/L, P=0.037).
- Systolic blood pressure and BD independently predicted blood transfusion requirements (hypotension OR 3.2, P=0.044; BD ≤ -8 mEq/L OR 15.3, P=0.003).
- Injury Severity Score and initial systolic blood pressure were not independent predictors of mortality.
Conclusions:
- The initial base deficit (BD) is a significant independent predictor of mortality and 24-hour blood transfusion requirements in pediatric trauma patients (excluding severe brain injury).
- Pediatric trauma patients with an initial BD of -8 mEq/L or less face substantially increased risks of mortality and transfusion.
- Initial BD serves as a crucial early warning marker for shock severity in pediatric trauma.
Objective:
The initial base deficit (BD) is an important indicator of shock in adult trauma patients, but its value is unclear in pediatric trauma patients. This study assessed the ability of the initial BD to predict mortality and blood transfusion requirements in children except severe brain injury patients.
Methods:
This study was a retrospective review of pediatric patients with severe trauma arriving at the emergency department of a university hospital from January 1998 to June 2005. Blood pressure, the initial BD, and the Injury Severity Score were assessed as independent predictors of mortality and the blood transfusion requirement using multiple regression analysis.
Results:
The study group constituted 102 patients. According to the multiple regression analysis results, the initial systolic blood pressure, Injury Severity Score, and blood transfusion requirement were not independent predictors of mortality (P = 0.104, 0.959, 0.386, respectively). By contrast, the initial BD was an independent predictor, with an odds ratio of 13.6 for BD of -8 mEq/L or less (confidence interval [CI], 3.51-35.23, P = 0.037), and systolic blood pressure and BD were independent predictors of blood transfusion requirement; the odds ratio for hypotension was 3.2 (CI, 0.51-8.32, P = 0.044), and the odds ratio was 15.3 for BD values of -8 or less (CI, 2.24-51.43, P = 0.003).
Conclusion:
The initial BD in pediatric trauma patients except severe brain injury was an independent predictor of mortality and blood transfusion requirement within 24 hours. Mortality and blood transfusion requirement were significantly high when initial BD was less than -8 mEq/L.
