BIG score is a strong predictor of mortality and morbidity for high-energy traumas in pediatric intensive care unit

BACKGROUND: Severe traumatic injuries not only constitute an important population of pediatric intensive care unit (PICU) but they also play a major role in mortality and morbidity. Mortality risk assessment of traumatic injuries in the PICU is a delicate issue as it influences the treatment decisions. BIG score (Base Deficit +[2.5 × INR] + [15-GCS]) and the Pediatric Trauma Score (PTS) are utilized in pediatric trauma centers for the assessment of trauma severity. In this research, we aimed to elucidate the predictivity of trauma severity scores, the PRISM-3 (pediatric risk of mortality), and admission laboratory parameters in pediatric patients with high-energy traumas.
METHODS: Children who had been exposed to high-energy polytraumas between 2018 and 2020 and treated in a tertiary care PICU were included in this retrospective analysis. Newly developed mental or motor disabilities, post-traumatic acquired epilepsy, requirement for tracheostomy, and/or extremity loss at PICU discharge were defined as morbidity. The PTS, the BIG score, PRISM-3 score, and admission laboratory parameters were utilized for mortality and morbidity prediction.
RESULTS: A total of 155 patients were included in the study. The median age of the participants were 66 months (25–134). The origin of trauma was fall from height in 45.2% (n=70) of the subjects and traffic accident 54.8% (n=85) of the cases. New morbidities had occurred in 8.7% (n=13) and 3.2% (n=5) of the patients deceased in the ICU. The results of logistic regression analysis indicated that BIG score (p=0.01), PTS (p=0.003), PRISM-3 (p=0.02), admission D-dimer (p=0.01), and albumin levels (p=0.001) were significantly associated with mortality. The receiver operating characteristics curve analysis denoted that BIG score (cutoff >21.5, area under the curve [AUC]: 0.984 95% CI: 0.943–0.988), PRISM-3 score (cutoff >18, AUC: 0.997 95% CI: 0.970–1), the PTS (cutoff ≤3, AUC: 0.969 95% CI: 0.928–0.990), admission albumin level (cutoff ≤3 g/dL, AUC: 0.987 95% CI: 0.953–0.998), and D-dimer level (cutoff >13,100 mcg/L, AUC: 0.776 95% CI: 0.689–0.849) all had high predictive values for mortality.
CONCLUSION: Regarding the results of this research, one can conclude that BIG score is a strong predictor of mortality and morbidity in high-energy pediatric traumas. Although PRISM-3 score has a similar predictive capability, the earlier and easier calculation as-sets of BIG score positions itself as a more useful and powerful predictor for mortality and morbidity in pediatric high-energy traumas.

Çocuk yoðun bakým ünitesindeki yüksek enerjili travma olgularýnda BIG skoru güçlü bir mortalite ve morbidite belirtecidir

AMAÇ: Ciddi travmatik yaralanmalar çocuk yoðun bakým hasta popülasyonunun önemli bir parçasý olduðu gibi mortalite ve morbiditenin de önemli nedenleri arasýndadýr. Çocuk yoðun bakým unitesinde mortalite riskinin deðerlendirilmesi, hasta bazlý tedavi kararlarýnýn alýnmasý ve kalite deðerlendirmesi açýsýndan önemli bir konudur. BIG skor (Baz açýðý+[2.5 x INR] + [15- GKS]) ve Pediatrik Travma Skoru pediatrik travma merkezlerinde travma ciddiyetinin deðerlendirilmesi amacýyla kullanýlmaktadýr. Bu çalýþmadaki amacýmýz, pediatrik yüksek enerjili travma olgularýnda travma þiddeti skorlarý, pediatrik mortalite risk skoru (PRISM – 3) ve yatýþ laboratuvar verilerinin mortaliteyi belirlemedeki rollerini tespit etmektir.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþma 2018–2020 yýllarý arasýnda 3. basamak bir çocuk yoðun bakým ünitesinde yürütüldü. Yüksek enerjili çoklu travma olgularý çalýþmaya dahil edildi. Yeni geliþen mental ya da motor bozukluklar, posttravmatik epilepsi, trakeostomi ihtiyacý ve ekstremite kaybý olmasý morbidite olarak tanýmlandý. Pediatrik travma skoru, BIG skor, PRISM – 3 skoru ve baþvuru laboratuvar incelemeleri mortalite ve morbidite tahmininde kullanýldý.
BULGULAR: Ortanca yaþlarý 66 (25–134) ay olan 155 olgu çalýþmaya dahil edildi. Altmýþ (%45.2) olgu yüksekten düþme nedeniyle 85 (%54.8) olgu ise motorlu taþýt kazasý nedeniyle yatýrýlmýþtý. On üç (%8.5) olguda taburculukta morbiditeler tespit edilirken beþ (%3,2) olgu yatýþ sýrasýnda hayatýný kaybetti. Lojistik regresyon analizinde BIG skoru (p=0.01), pediatrik travma skoru (p=0.003), pediatrik mortalite risk skoru (p=0.02), yatýþ D-dimer deðeri (p=0.01) ve yatýþ albumin deðeri (p=0.001) mortaliteyle anlamlý olarak iliþkili bulundu. ROC analizinde ise BIG skoru (kestirim deðeri >21.5, AUC: 0.984 %95 GA: 0.943–0.988), pediatrik mortalite risk skoru (kestirim deðeri >18, AUC: 0.997 %95 GA: 0.970–1), pediatrik travma skoru (kestirim deðeri ≤3, AUC: 0.969 &95 GA: 0.928–0.990,) baþvuru albumin düzeyi (kestirim deðeri ≤3 g/dL, AUC: 0.987 %95 CI: 0.953–0.998) ve baþvuru D-dimer düzeylerinin (kestirim deðeri >13100 mcg/L, AUC: 0.776 %95 GA: 0.689–0.849) mortalite açýsýnda yüksek düzeyde prediktif olduðu görüldü.
TARTIÞMA: BIG skoru, pediatrik yüksek enerjili travma hastalarýnda güçlü bir mortalite ve morbidite prediktörü olarak görünmektedir. Pediatrik mortalite risk skoru, BIG skoruyla benzer prediktif deðere sahip görünse de çok daha erken ve hýzla deðerlendirilebilir olmasý nedeniyle BIG skoru daha kullanýþlý ve güçlü bir prediktör olarak ön plana geçmektedir.