Predicting Functional Outcomes in Adult Traumatic Brain Injuries Using the Base Deficit, International Normalized...

Up to 70% of early deaths in traumatic brain injuries are due to withdrawal of care. However, many of these patients could have made a good recovery. A reliable prognostic indicator would thus be useful for early decision-making. We sought to determine the association between the Base Deficit, International Normalized Ratio, and Glasgow Coma Scale (GCS) (BIG) score and functional outcomes within 1 y postinjury.

A meta-analysis was conducted using the Federal Interagency Traumatic Brain Injury Research Informatics System. Two multicenter prospective studies from 2006 to 2018 were selected. Patients over 17 y old were categorized on if they had a BIG score >8 24 h postadmission and a Glasgow Outcome Scale Extended (GOS-E) <5 1 y postinjury. Univariate and multivariate logistic regressions yielded odds ratios and 95% confidence intervals.

In total, 329 patients were identified. One hundred forty-seven patients had a GOS-E <5 while 182 had a GOS-E ≥5. The median BIG score at 24 h was 11.5 for patients with a GOS-E <5 and 6.8 with a GOS-E ≥5 (P < 0.001). A BIG score >8 predicted poor 1-y functional outcomes (OR = 5.29, P < 0.001). The BIG score had a greater sensitivity than GCS (75.5% and 70.7%, respectively) and a comparable negative predictive value (76.2% and 77.1%, respectively).

The BIG score is a promising prognostic tool to predict short-term functional outcome in patients with traumatic brain injury. It has a greater ability than GCS to identify patients that may have poor functionality and is comparable discriminating between good and poor functional outcomes.