Ulus Travma Acil Cerrahi Derg. 2025; 31(1): 66-74 | DOI: 10.14744/tjtes.2024.92879

Predicting mortality in adults hospitalized with multiple trauma: Can the BIG score estimate risk?

Adem Az, Özgür Söðüt, Mehmet Özçömlekçi, Yunus Doðan, Tarýk Akdemir
Department of Emergency Medicine, University of Health Sciences, Haseki Training and Research Hospital, Istanbul-Türkiye

BACKGROUND: This study aimed to compare the predictive performance of the BIG score (base deficit + [2.5 × international normalized ratio (INR)] + [15 – Glasgow Coma Scale (GCS)]) for in-hospital mortality in adult patients with multiple trauma against other scoring systems, including the Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and Injury Severity Score (ISS).
METHODS: A retrospective single-center study was conducted, including 563 adults (aged ≥18 years) with multiple trauma who were admitted to the emergency department and hospitalized between January 2022 and December 2023. Demographic and clinical characteristics, as well as trauma scoring systems (e.g., GCS, RTS, ISS, and BIG score), were analyzed between survivors and nonsurvivors to identify factors associated with in-hospital mortality.
RESULTS: The BIG score, along with the RTS and ISS, was identified as an independent predictor of mortality in adults with multiple trauma (p<0.001 for all comparisons). A BIG score of 10.65 was determined as the mortality cut-off, with 67.7% sensitivity and 86.5% specificity (area under the curve: 0.847; 95% confidence interval: 0.808–0.886). The BIG score demonstrated higher positive predictive value (60.8%) and negative predictive value (89.6%) compared to the other trauma scoring systems. Estimated mortality risks for BIG scores of 15 and 20 were 50% and 80%, respectively.
CONCLUSION: The BIG score can accurately predict in-hospital mortality in adults with multiple trauma. Additionally, the BIG score was superior to the GCS, RTS, and ISS in predicting in-hospital mortality (ClinicalTrials.gov identifier: NCT06574464).

Keywords: BIG (base deficit, international normalized ratio, and Glasgow Coma Scale) score, Revised Trauma Score, Injury Severity Score, mortality, multiple trauma.

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Çoklu travma nedeniyle hastaneye kaldýrýlan yetiþkinlerde mortalite tahmini: BIG skoru riski tahmin edebilir mi?

Adem Az, Özgür Söðüt, Mehmet Özçömlekçi, Yunus Doðan, Tarýk Akdemir
Acil Týp Kliniði, Saðlýk Bilimleri Üniversitesi, Haseki Eðitim ve Araþtýrma Hastanesi, Istanbul-Türkiye

AMAÇ: Glasgow koma skoru (GKS), revize travma skoru (RTS) ve yaralanma þiddeti skoru (YÞS) ile yetiþkin çoklu travma hastalarýnda hastane içi mortalite için BIG skorunun (Baz eksisi + [2.5×INR] + [15–GKS]) öngörücü performansýný karþýlaþtýrmak.
GEREÇ VE YÖNTEM: Bu retrospektif tek merkezli çalýþmaya, Ocak 2022 ile Aralýk 2023 arasýnda acil servisimize baþvuran ve hastaneye yatýrýlarak takip edilen çoklu travmasý olan 563 yetiþkin (≥18 yaþ) alýndý. Hastalarýn demografik ve klinik özellikleri ve travma skorlarý (örn. GKS, RTS, YÞS ve BIG skoru), hastane içi mortalite ile iliþkili faktörleri belirlemek için sað kalanlar ve sað kalmayanlar arasýnda karþýlaþtýrýldý.
BULGULAR: BIG skoru, RTS ve YÞS ile birlikte çoklu travmasý olan yetiþkinlerde mortalitenin baðýmsýz bir öngörücüsüydü (tüm karþýlaþtýrmalar için p<0.001). BIG skoru için 10.65, %67.7 duyarlýlýk ve %86.5 özgüllükle ölüm oraný için kesme noktasý olarak belirlenmiþtir (eðri altýndaki alan 0.847, %95 güven aralýðý 0.808-0.886). BIG skoru, diðer travma skorlarýndan daha büyük pozitif (%60.8) ve negatif (%89.6) öngörü deðerlerine sahipti. Tahmini ölüm riski, sýrasýyla 15 ve 20 olan BIG skorlarý için %50 ve %80 idi.
SONUÇ: BIG skoru, çoklu travmasý olan yetiþkinlerde hastane içi ölüm oranýný doðru bir þekilde tahmin edebilir. Dahasý, BIG skoru hastane içi ölüm oranýný tahmin etmede GKS, RTS ve YÞS'den üstündü (ClinicalTrials.gov numarasý, NCT06574464).

Anahtar Kelimeler: BIG skor, revize travma skoru, yaralanma þiddeti skoru mortalite, çoklu travma

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