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How significant is the BIG score in childhood traumatic brain injury?
Nazan Ulgen Tekerek1, Erdem Cebisli2, Mine Erkan3
1Pediatric Intensive Care Unit, Faculty of Medicine, Department of Child Health and Diseases Secretariat, Akdeniz University, Akdeniz University Hospital, Dumlupınar Boulevard, Campus, H Block 2 Floor, 07070, Antalya, Turkey. nazanulgen@gmail.com.
Insights
The BIG score effectively predicts mortality in pediatric traumatic brain injury (TBI) patients. This simple scoring system demonstrates high reliability and accuracy, comparable to other established measures.
Area of Science:
- Pediatric critical care medicine
- Neurotraumatology
- Clinical scoring systems
Background:
- Traumatic brain injury (TBI) is a significant cause of mortality in children.
- Evaluating the reliability of scoring systems is crucial for accurate prognosis.
Purpose of the Study:
- To assess the predictive reliability of the BIG score for mortality in pediatric TBI.
- To compare the BIG score's performance against other established scoring systems.
Main Methods:
- Retrospective analysis of pediatric TBI patients admitted to a tertiary reference hospital's Pediatric Intensive Care Unit (PICU) between 2014 and 2019.
- Evaluation of the BIG score, Injury Severity Score (ISS), and Pediatric Risk of Mortality (PRISM) III.
Main Results:
- The BIG score, ISS, and PRISM III were significantly higher in non-survivors (p < 0.001).
- The BIG score demonstrated high accuracy (AUC 0.962) in predicting mortality, comparable to ISS (AUC 0.952) and PRISM III (AUC 0.981).
- In isolated TBI cases, the BIG score showed superior predictive value (AUC 0.988).
Conclusions:
- The BIG score is a simple and rapidly calculated tool for predicting mortality and disease severity in pediatric TBI.
- Further prospective studies are recommended to validate these findings in larger cohorts.
Background:
This study aims to evaluate the reliability of the BIG score in predicting mortality in children with traumatic brain injury (TBI) and to compare it with the literature and other scoring systems.
Methods:
Patients who were followed up in the Pediatric Intensive Care Unit (PICU) for TBI between 2014 and 2019 in a tertiary reference hospital were evaluated retrospectively.
Results:
One hundred fifty-nine patients met the inclusion criteria. The most common injury mechanisms were falling from a height (39.6%). The mortality rate was 12.6% (n = 20). The mean BIG score, ISS, and PRISM III were statistically significantly higher in the mortality group (p < 0.001). The AUC values found in the ROC analysis in the whole study group, respectively, 0.962 (CI 0.920-0.986) for the BIG score, 0.952 (CI 0.906-0.979) for the ISS, 0.957 (CI 0.913-0.983) for the GCS, and 0.981 (CI 0.946-0.996) for the PRISM III. In the patients with isolated TBI, the AUC value for the BIG score was 0.988 (0.967-1.000) and higher than the ISS and PRISM 3 [0.983 (0.956-1.000), 0.969 (0.932-1.000) respectively]). The cut-off point for the BIG score in the whole group was 19 (sensitivity 95%, specificity 88%, positive predictive value 0.58, negative predictive value 0.99). In logistic regression model, we found that BIG score is an independent variable for mortality (AOR:1.4, 95%CI 1.22-1.63).
Conclusion:
In children with traumatic brain injury, the BIG score is simple, quickly calculated, and a good predictor of mortality and disease severity. Prospective studies with more extensive series are needed on this subject.
