Performance of the BIG Score in Predicting Mortality in Normotensive Children With Trauma

Area of Science:

• Pediatric Trauma Research
• Clinical Scoring Systems
• Emergency Medicine

Background:

• Children possess a greater physiological reserve during traumatic hemorrhagic shock.
• Existing trauma scores may not adequately capture mortality risk in normotensive pediatric patients.
• The BIG score (Base deficit, International Normalized Ratio, Glasgow Coma Scale) has shown promise in predicting mortality.

Purpose of the Study:

• To validate the predictive performance of the BIG score for mortality in normotensive pediatric trauma patients.
• To compare the BIG score's accuracy against established trauma scoring systems.

Main Methods:

• Retrospective review of 1046 injured children (<18 years) admitted to a Korean academic hospital (2010-2018).
• Exclusion of patients with age-adjusted hypotension.
• Calculation and comparison of Areas Under the Curve (AUCs) for the BIG score, Revised Trauma Score, and Pediatric Trauma Score for in-hospital mortality prediction.

Main Results:

• The study enrolled 554 children with a 4.9% in-hospital mortality rate.
• The BIG score demonstrated a higher AUC (0.94) for mortality prediction compared to the Pediatric Trauma Score (0.87; P < 0.001).
• The BIG score showed a trend towards better performance than the Revised Trauma Score (AUC 0.90; P = 0.130), with a strong correlation between in-hospital and BIG-predicted mortalities.

Conclusions:

• The BIG score is a highly accurate tool for predicting mortality in normotensive pediatric trauma patients.
• The BIG score's components (base deficit, INR, GCS) effectively capture critical physiological derangements in pediatric trauma.
• This validation supports the clinical utility of the BIG score in managing critically injured children.