Can the BIG score reliably predict outcomes in pediatric traumatic brain ınjury?
Abdulrahman Özel1, Servet Yüce2, Esma Şengenç3
1Pediatric Intensive Care Unit, Department of Pediatrics, Bağcılar Training and Research Hospital, University of Health Sciences Türkiye, Merkez District, Dr. Sadık Ahmet Street. No:5, 34200, Istanbul, Türkiye. dr.abdulrahman.ozel@gmail.com.
Insights
The BIG score effectively predicts mortality and functional outcomes in pediatric traumatic brain injury (TBI) patients. This rapid assessment tool shows strong prognostic value, aiding clinical decision-making in TBI care.
Area of Science:
- Pediatric Critical Care Medicine
- Neurotrauma Research
- Clinical Prognostics
Background:
- Traumatic brain injury (TBI) is a significant cause of mortality and long-term disability in children.
- Accurate prognostic tools are crucial for guiding treatment and resource allocation in pediatric TBI management.
- Existing scores may have limitations in predicting diverse outcomes in this population.
Purpose of the Study:
- To evaluate the prognostic capability of the BIG score for predicting mortality in pediatric TBI.
- To assess the BIG score's effectiveness in predicting functional outcomes at discharge among pediatric TBI survivors.
- To compare the predictive performance of the BIG score against established scores like pGCS, PTS, and PRISM III.
Main Methods:
- Retrospective analysis of 103 pediatric TBI patients admitted to a tertiary hospital's PICU (2020-2024).
- Functional outcomes assessed using the Functional Status Scale (FSS) at discharge.
- Receiver operating characteristic (ROC) analysis employed to determine the predictive accuracy of BIG score, PTS, pGCS, and PRISM III for mortality and functional impairment.
Main Results:
- The BIG score demonstrated superior predictive accuracy for mortality (AUC=0.966) compared to PRISM III, pGCS, and PTS.
- For functional impairment, the BIG score (AUC=0.815) also showed strong predictive value, outperforming other scores.
- Strong correlations were found between FSS scores and mechanical ventilation duration (r=0.786) and PICU length of stay (r=0.706).
Conclusions:
- The BIG score is a rapid and reliable predictor of both mortality and functional outcomes in pediatric TBI.
- The BIG score outperformed the pGCS in predicting outcomes, particularly in patients with an initial pGCS of 3.
- Further prospective studies are recommended to validate these findings and establish the BIG score's role in clinical practice.
Purpose:
This study aimed to evaluate the prognostic value of the BIG score in predicting mortality and functional outcomes in pediatric patients with traumatic brain injury (TBI).
Methods:
A retrospective analysis was conducted on pediatric TBI patients admitted to the Pediatric Intensive Care Unit (PICU) between 2020 and 2024 at a tertiary hospital. Functional outcomes at discharge were assessed using the Functional Status Scale (FSS). Receiver operating characteristic (ROC) analysis determined the predictive accuracy of the BIG score, Pediatric Trauma Score (PTS), Pediatric Glasgow Coma Scale (pGCS), and Pediatric Risk of Mortality III (PRISM III).
Results:
A total of 103 patients were included. The mortality rate was 13.6% (n = 14), and 21.4% of survivors had functional impairment at discharge. In non-survivors, the BIG score, PTS, pGCS, and PRISM III were significantly elevated (all p < 0.001). The AUC for predicting mortality was 0.966 (BIG score), 0.911 (PRISM III), 0.909 (pGCS), and 0.827 (PTS). For functional impairment, the AUC values were 0.815 (BIG score), 0.812 (pGCS), 0.715 (PRISM III), and 0.645 (PTS). Correlation analysis showed a strong association between FSS scores and mechanical ventilation duration (r = 0.786, p < 0.001) and PICU length of stay (r = 0.706, p < 0.001).
Conclusion:
The BIG score is a rapid, reliable predictor of mortality and functional outcomes in pediatric TBI patients, outperforming pGCS in patients with an initial pGCS of 3. Prospective studies are needed for further validation.
