Use of the BIG score to predict mortality in pediatric trauma
Jeff Bolstridge1, Erika R O'Neil2, James K Aden1
1Brooke Army Medical Center, Department of Pediatrics, MCHE-ZDP, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234, United States of America.
Insights
The BIG score effectively predicts in-hospital mortality in pediatric trauma patients, performing comparably to established scores like PELOD, PIM2, and PRISM III. This validates the BIG score for assessing pediatric trauma severity.
Area of Science:
- Pediatric critical care medicine
- Trauma surgery
- Medical scoring systems
Background:
- The BIG score (Base deficit, International Normalized Ratio, GCS) is a validated tool for predicting in-hospital mortality in pediatric trauma patients.
- Established pediatric trauma severity scores include PELOD, PIM2, and PRISM III.
Purpose of the Study:
- To compare the mortality prediction accuracy of the pediatric trauma BIG score against PELOD, PIM2, and PRISM III.
- To validate the BIG score in a large cohort of pediatric trauma patients.
Main Methods:
- Retrospective cohort study utilizing a multi-institutional database (2009-2015).
- Inclusion of pediatric patients with traumatic injury and recorded initial GCS.
- Calculation of BIG, PELOD, PIM2, and PRISM III scores; derivation of Receiver Operator Characteristic curves.
- Comparison of mortality prediction performance using Area Under the Curve (AUC).
Main Results:
- Analysis included 29,204 pediatric trauma patients.
- AUC values were: BIG score (0.97), PELOD (0.98), PIM2 (0.98), and PRISM III (0.99).
- The BIG score demonstrated high sensitivity (0.937) and specificity (0.938) at a cutoff of 16.
Conclusions:
- The BIG score, even with imputation of missing variables, performs similarly to PELOD, PIM2, and PRISM III in predicting mortality.
- These findings further validate the BIG score as a reliable predictor of mortality in pediatric trauma patients.
Objective:
The BIG score, which is comprised of admission base deficit (B), International Normalized Ratio (I), and GCS (G), is a severity of illness score that can be used to rapidly predict in-hospital mortality in pediatric patients presenting following traumatic injury. We sought to compare the mortality prediction of the pediatric trauma BIG score with other well-established pediatric trauma severity of illness scores: the pediatric logistic organ dysfunction (PELOD); the pediatric index of mortality 2 (PIM2); and the pediatric risk of mortality (PRISM III).
Methods:
In this retrospective cohort study, data from 2009 to 2015 was collected using a multi-institutional database. All pediatric patients admitted following traumatic injury with a recorded initial GCS were included. BIG, PELOD, PIM2, and PRISM III scores were calculated, and Receiver Operator Characteristic curves were derived for all severity of illness scores. Mortality prediction performance for each score was compared by the area under the curve (AUC).
Results:
A total of 29,204 patients were included in this analysis. AUC for BIG, PELOD, PIM2, and PRISM III scores were 0.97 (0.97-0.98), 0.98 (0.98-0.98), 0.98 (0.97-0.98), and 0.99 (0.98-0.99), respectively. At the optimum cut-off point of 16, the BIG score had a sensitivity of 0.937, specificity of 0.938, positive predictive value of 0.514, and negative predictive value of 0.995.
Conclusions:
In this massive cohort of pediatric trauma patients, the BIG score using imputation of missing variables performed similarly to the PELOD, PIM2, and PRISM III, further validating the score as a predictor of mortality.
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