The BIG Score and Prediction of Mortality in Pediatric Blunt Trauma

Area of Science:

• Pediatric Trauma Care
• Emergency Medicine
• Critical Care Medicine

Background:

• Blunt trauma is a leading cause of death in children.
• Accurate early risk stratification is crucial for effective management of pediatric trauma patients.
• Existing scoring systems may not fully capture the severity of illness in pediatric blunt trauma.

Purpose of the Study:

• To evaluate the BIG score's (Base deficit, International normalized ratio, Glasgow Coma Scale) association with in-hospital mortality in pediatric blunt trauma.
• To assess the BIG score's predictive power independent of pre-hospital interventions and patient characteristics.
• To determine the BIG score's utility in predicting mortality among pediatric trauma patients admitted to the ICU.

Main Methods:

• Retrospective review of a trauma database (2001-2012) for pediatric patients (≤17 years) with blunt trauma and Injury Severity Score ≥ 12.
• Analysis included in-hospital mortality, BIG score components on emergency department arrival, pre-hospital intubation, fluid administration, hypotension, and head injury.
• Statistical analysis to determine independent predictors of mortality and assess the BIG score's predictive accuracy using receiver operating characteristic curves.

Main Results:

• The BIG score was an independent predictor of mortality (OR 11).
• Patients with a BIG score ≥ 16 had a significantly higher death rate (38%) compared to those with BIG <16 (0.6%).
• The BIG score accurately predicted mortality in the ICU population (OR 14.3).

Conclusions:

• The BIG score is a reliable predictor of mortality in pediatric blunt trauma patients.
• A BIG score <16 identifies children with a high probability of survival.
• The BIG score remains a valuable tool for risk stratification in critically ill pediatric trauma patients requiring ICU admission.