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Base Deficit, International Normalized Ratio, and Glasgow Coma Scale (BIG) is a Predictor Tool for Survival and
Liqaa Raffee1, Abdel-Hameed W Al-Mistarehi2, Khaled Alawneh3
1Department of Accident and Emergency Medicine, Jordan University of Science and Technology, Irbid, JOR.
Insights
The BIG Score effectively predicts survival and mortality in pediatric trauma patients. A cutoff of ≥10.0 accurately identifies mortality risk, with greater accuracy in predicting survival.
Area of Science:
- Trauma Care
- Pediatric Emergency Medicine
- Clinical Prognostic Scores
Background:
- Accurate survival and mortality estimation is crucial for pediatric trauma patient triage and care stratification.
- The BIG Score, comprising base deficit, INR, and GCS, is a recognized tool for mortality prediction.
- This study validates the BIG Score's utility in pediatric trauma settings.
Purpose of the Study:
- To evaluate the effectiveness of the BIG Score in predicting survival and mortality rates among pediatric trauma patients.
- To determine an optimal cutoff point for the BIG Score in this population.
- To assess the BIG Score's prognostic value in a real-world clinical setting.
Main Methods:
- A retrospective study of 424 pediatric trauma patients (<18 years) treated between 2014-2019.
- Collection of demographic data, trauma specifics, and laboratory results, including base deficit, INR, and GCS.
- Calculation of BIG Scores and generation of a ROC curve to identify the optimal cutoff point for mortality prediction.
Main Results:
- The BIG Score with a cutoff of ≥10.0 demonstrated high sensitivity (88.5%) and specificity (76.3%) for mortality prediction.
- Significantly lower pH and GCS values, and higher base deficit and INR values were observed in non-survivors.
- The BIG Score accurately predicted survival in 100% of patients with scores between 2.1 and 6, showing higher accuracy for survival prediction than mortality.
Conclusions:
- The BIG Score is a valuable, simple, and rapid tool for assessing prognosis in pediatric trauma patients.
- A BIG Score cutoff of ≥10.0 is highly effective for predicting mortality in this group.
- The BIG Score exhibits superior accuracy in predicting survival outcomes compared to mortality prediction in pediatric trauma.
Background:
An accurate estimate of the survival and mortality at the initial trauma evaluation is essential to ensure appropriate triage and stratification of the patients for progressive care. One of the recognized tools for predicting mortality is the BIG Score, composed of admission base deficit, international normalized ratio (INR), and Glasgow Coma Scale (GCS). This study evaluates the BIG scale in predicting survival and mortality rates among pediatric trauma patients.
Methods:
Pediatric trauma patients, aged <18 years, visiting the emergency department of a tertiary hospital in the North of Jordan from 2014 to 2019 were included. Demographic data, trauma details, and lab results were collected. The BIG score for each patient was calculated. A receiver operator characteristic (ROC) curve was generated to determine the best suitable BIG cutoff point and its probabilities.
Results:
A total of 424 patients were included in this study. About two-thirds of the patients were males (n=298). The mean±SD of pH and GCS values were significantly lower among dead patients (6.0±2.5, 3.7±3.9, respectively) in comparison to alive ones (7.3±2.7, 11.5±5.5, respectively) (p=0.026, p<0.001, respectively). On the other hand, base deficit and INR values were significantly higher among dead patients (6.5±6.2, 1.9±2.5, respectively) than alive ones (1.9±3.6, 0.8±0.5, respectively), (p<0.001). The BIG score with a cutoff point of ≥10.0 has a high sensitivity (88.5%) and specificity (76.3%) for mortality prediction. The survival rate was correctly predicted in 100% of patients with a BIG score between 2.1 and 6. Also, the best survival predictions were seen in intubated patients (100%), followed by RTA-related trauma and ICU admission with decreasing frequency.
Conclusions:
The current study has shown the added value of the BIG score as a simple and rapid tool to predict prognosis in pediatric trauma settings. The BIG score with a cutoff point of ≥10.0 is highly efficient in predicting pediatric trauma patients' mortality rates. However, the BIG score demonstrates greater accuracy in predicting survival outcomes compared to its ability to predict mortality among pediatric trauma patients.
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