RETROSPECTIVE EVALUATION OF THE BIG SCORE TO PREDICT MORTALITY IN PEDIATRIC BLUNT TRAUMA

Abstract

BACKGROUND: The BIG score is a new pediatric trauma score composed of the admission Base deficit, the International Normalized Ratio and the Glasgow Coma Scale. A score < 16 identifies children with a high probability of survival following blunt trauma. OBJECTIVES: To measure the criterion validity of the BIG score to predict in-hospital mortality among children visiting an emergency department with blunt trauma requiring an admission to the intensive care unit. DESIGN/METHODS: This was a retrospective cohort study performed in a single tertiary care pediatric hospital between 2008 and 2016. Participants were all children (< 18 years) visiting the emergency department for a blunt trauma requiring intensive care unit admission or who died at the emergency department. All charts were reviewed by a member of the research team using a standardized report form. To insure quality of data abstraction, 10% of the charts were reviewed in duplicate by a second rater blinded to the first evaluation. The primary outcome was in-hospital mortality. Baseline demographics, components of the BIG score upon arrival to the emergency department, and disposition were extracted. The primary analysis was the association between the BIG score and mortality. It was calculated that the inclusion of at least 25 deaths would provide confidence intervals of +/- 0.15 for proportions. RESULTS: Twenty-eight children died among the 336 who met the inclusion criteria. The inter-rater agreement for data abstraction was excellent for the 36 charts reviewed in duplicate with kappa scores or interclass correlation coefficients > 0.8 for all data. 284 children had information on the three components of the BIG score and they were included in the primary analysis. A BIG score > 16 demonstrated a sensitivity of 0.93 (95%CI: 0.76–0.98) and specificity of 0.83 (95%CI 0.78–0.87) to identify mortality. Using ROC curves, the area under the curve was statistically better for the BIG score (0.97) in comparison to the ISS (0.70) or to the individual components of the score. CONCLUSION: The BIG score is an excellent predictor of survival for children visiting the emergency department following a blunt trauma.