Pediatric Trauma BIG Score

Why Use

Simple, rapid, and accurate scoring system to evaluate the severity of illness and predict mortality in children. Can be applied to both blunt and penetrating traumatic injuries. Useful in quantifying degree of physiological derangement beyond clinical appearance and GCS alone. Base deficit and INR are physiologic measures of hypoperfusion and trauma-induced coagulopathy, respectively, and both play critical roles in trauma-related mortality.

When to Use

Pediatric patients under 18 years of age, after blunt or penetrating trauma or penetrating blast injury.

Formula

Pearls / Pitfalls

BIG is an acronym for the components of the score: base deficit, INR, and GCS. Initial analysis ( Borgman 2011 ) had more penetrating trauma and penetrating blast injuries, compared with the excluded patients who had more blunt injuries and burns. These were accounted for in the external validation, however. May facilitate communication regarding prognosis with families and during patient transfer ( Davis 2015 ). If point of care testing is used, INR and base deficit results can be obtained in ~2 minutes ( Borgman 2015 ).

Management

Management of pediatric trauma patients depends on injuries diagnosed.

Advice

BIG Score alone should not direct clinical care because patients with BIG Scores <16 still require intensive care and trauma surgery services and should receive care at level 1 pediatric trauma centers ( Davis 2015 ).

More Information

Predicted in-hospital mortality = 1/(1 + e -B ), where B = 0.2 × (BIG Score) – 5.208 Note: Pediatric BIG Score of 26 (i.e., base deficit 10, INR 3.6, GCS 8) predicts a mortality of 50% with a positive predictive value of 65%, negative predictive value of 93%, and specificity of 99% ( Borgman 2011 ). Davis et al (2015) report the optimal BIG Score cutoff as 16. Mortality with cutoff <16 was 3/496 (0.6%, 95% CI 0.001-0.007) vs ≥16 which was 47/125 (ROC 38%, 95% CI 0.15-0.7) with p <0.0001.