Retrospective evaluation of the BIG score to predict mortality in pediatric blunt trauma

Grandjean-Blanchet, Charlotte; Émériaud, Guillaume; Beaudin, Marianne; Gravel, Jocelyn

doi:10.1017/cem.2017.379

Cited by 11 publications

(11 citation statements)

References 26 publications

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“…The study children had an older median age, and lower median BIG score and in-hospital mortality rate compared with the equivalent values of other validation studies. 10,20 Even in this different setting, the AUC of the score was comparable with the previously reported values ranging from 0.89 to 0.97. 9,10,20 This finding suggests its robust mortality-predicting accuracy in children without hypotension.…”

Section: Discussionsupporting

confidence: 88%

“…10,20 Even in this different setting, the AUC of the score was comparable with the previously reported values ranging from 0.89 to 0.97. 9,10,20 This finding suggests its robust mortality-predicting accuracy in children without hypotension. The BIG score has strengths in early prediction of children's traumatic mortality compared with RTS and PTS.…”

Section: Discussionsupporting

confidence: 88%

“…The BIG score should be judiciously used in children with TBI owing to its large impact on mortality even with relatively low scores. In this study, the nonsurvivors showed lower scores than those previously reported (20.1 vs 25.5-27.3 10,20 ). Also, the cutoff of 12.1 to achieve a 92.6% sensitivity was lower than the reported cutoff of 16 to achieve a 93% to 94% sensitivity.…”

Section: Discussioncontrasting

confidence: 81%

“…Also, the cutoff of 12.1 to achieve a 92.6% sensitivity was lower than the reported cutoff of 16 to achieve a 93% to 94% sensitivity. 10,20 This gap may be explained by the presence of the 4 TBI children whose BIG scores <16.8 and BD <6.0 mmol/L (children C-F in Table 3). These children can be said as having near-isolated abnormal GCS.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, the BIG score, which consists of base deficit (BD), international normalized ratio (INR), and the Glasgow Coma Scale (GCS), has been reported to outperform other scores in prediction of children's traumatic mortality. [9][10][11] Instead of hypotension, BD and INR reflect implications of hemorrhage so that BIG score can be valuable in early prediction of preventable death. To our knowledge, this score remains to be validated specifically in normotensive children.…”

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confidence: 99%

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Performance of the BIG Score in Predicting Mortality in Normotensive Children With Trauma

Yoon

Ko²,

Lee³

et al. 2020

Pediatr Emer Care

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Objectives: Children have a larger reserve for traumatic hemorrhagic shock, requiring a score that uses physiologic variables other than hypotension. Recently, the BIG score comprising admission base deficit, international normalized ratio, and the Glasgow Coma Scale has been reported to predict traumatic mortality. We aimed to validate the performance of the BIG score in mortality prediction of normotensive children with trauma. Methods:We reviewed 1046 injured children (<18 years) who visited a Korean academic hospital from 2010 to 2018, excluding those with ageadjusted hypotension. In-hospital mortality, the BIG score and its predicted mortality, Revised Trauma Score, and Pediatric Trauma Score were calculated. We compared areas under the curve (AUCs) for in-hospital mortality of the 3 scores and did in-hospital and BIG-predicted mortalities.Results: Of the 1046 children, 554 were enrolled with a 4.9% in-hospital mortality rate. The median BIG score was higher in the nonsurvivors (6.4 [interquartile range, 4.4-9.2] vs 20.1 [16.5-24.8]; P < 0.001). The AUC of the BIG score was 0.94 (95% confidence interval [CI], 0.92-0.96), which was higher than that of Pediatric Trauma Score (0.87 [95% CI, 0.84-0.90]; P < 0.001). The AUC of the BIG score tended to be higher than that of Revised Trauma Score without statistical significance (0.90 [95% CI, 0.87-0.92]; P = 0.130). We noted a parallel between in-hospital and BIG-predicted mortalities. The hemorrhage-related nonsurvivors showed higher median base deficit and BIG score than did the isolated traumatic brain injury-related ones. Conclusions:The BIG score can predict mortality with excellent accuracy in normotensive children with trauma.

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