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VOLUME 20 , ISSUE 11 ( 2016 ) > List of Articles


Pediatric trauma BIG score: Predicting mortality in polytraumatized pediatric patients

Mohamed El-Gamasy, Ahmed Elezz, Ahmed Basuni, Mohamed Elrazek

Keywords : BIG score, mortality, polytrauma in pediatric, trauma, trauma scoring

Citation Information : El-Gamasy M, Elezz A, Basuni A, Elrazek M. Pediatric trauma BIG score: Predicting mortality in polytraumatized pediatric patients. Indian J Crit Care Med 2016; 20 (11):640-646.

DOI: 10.4103/0972-5229.194011

License: CC BY-ND 3.0

Published Online: 01-10-2017

Copyright Statement:  Copyright © 2016; The Author(s).


Background: Trauma is a worldwide health problem and the major cause of death and disability, particularly affecting the young population. It is important to remember that pediatric trauma care has made a significant improvement in the outcomes of these injured children. Aim of the Work: This study aimed at evaluation of pediatric trauma BIG score in comparison with New Injury Severity Score (NISS) and Pediatric Trauma Score (PTS) in Tanta University Emergency Hospital. Materials and Methods: The study was conducted in Tanta University Emergency Hospital to all multiple trauma pediatric patients attended to the Emergency Department for 1 year. Pediatric trauma BIG score, PTS, and NISS scores were calculated and results compared to each other and to observed mortality. Results: BIG score ≥12.7 has sensitivity 86.7% and specificity 71.4%, whereas PTS at value ≤3.5 has sensitivity 63.3% and specificity 68.6% and NISS at value ≥39.5 has sensitivity 53.3% and specificity 54.3%. There was a significant positive correlation between BIG score value and mortality rate. Conclusion: The pediatric BIG score is a reliable mortality-prediction score for children with traumatic injuries; it uses international normalization ratio (INR), Base Excess (BE), and Glasgow Coma Scale (GCS) values that can be measured within a few minutes of sampling, so it can be readily applied in the Pediatric Emergency Department, but it cannot be applied on patients with chronic diseases that affect INR, BE, or GCS.

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  1. Gilbert JC, Arbesman MC. Pediatric injury scoring and triage methodology. In: Ziegler MM, Azizkhan RG, Weber TR, editors. Operative Pediatric Surgery. 1st ed. New York, United States of America: McGraw-Hill Professional; 2003. p. 1089-95.
  2. Marcin JP, Pollack MM. Triage scoring systems, severity of illness measures, and mortality prediction models in pediatric trauma. Crit Care Med 2002;30 11 Suppl: S457-67.
  3. Furnival RA, Schunk JE. ABCs of scoring systems for pediatric trauma. Pediatr Emerg Care 1999;15:215-23.
  4. Borgman MA, Maegele M, Wade CE, Blackbourne LH, Spinella PC. Pediatric trauma BIG score: Predicting mortality in children after military and civilian trauma. Pediatrics 2011;127:e892-7.
  5. Vavilala MS, Dunbar PJ, Rivara FP, Lam AM. Coagulopathy predicts poor outcome following head injury in children less than 16 years of age. J Neurosurg Anesthesiol 2001;13:13-8.
  6. Holcomb JB, McMullin NR, Pearse L, Caruso J, Wade CE, Oetjen-Gerdes L, et al. Causes of death in U.S. special operations forces in the global war on terrorism: 2001-2004. Ann Surg 2007;245:986-91.
  7. Shah K, Rabrich J. Essential emergency trauma. Emerg Med J 2011;978:111-6.
  8. Khothari CR, editor. Research Methodology, Methods and Techniques. 2nd ed. New Delhi: New Age International; 2012. p. 95-7.
  9. Bunn F, Kwan I, Roberts I. Effectiveness of Prehospital trauma care, Cochrane Injuries Group, Public health intervention Search Unit, Department of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine. Available from: [Last accessed on 2001 Oct 05].
  10. Fiorentino JA, Molise C, Stach P, Cinder P, Solla MM, Hoffman E, et al. Pediatric trauma. Epidemiological study among patients admitted to Hospital de Niños “Ricardo Gutiérrez”. Arch Argent Pediatr 2015;113:12-20, I-V.
  11. Derakhshanfar H, Hatamabadi H, Karimian K. The prognosis of trauma among children and the factors contributing to it the Road Traffic Injuries Research Network. Health 2012;4:212-5. Available from: [Last accessed on 2012 Dec 21].
  12. Letts M, Davidson D, Lapner P. Multiple trauma in children: Predicting outcome and long-term results. Can J Surg 2002;45:126-31.
  13. Nakayama DK, Copes WS, Sacco WJ. The effect of patient age upon survival in pediatric trauma. J Trauma 1991;31:1521-6.
  14. Vallipakorn SA, Plitapolkarnpim A, Suriyawongpaisal P, Techakamolsuk P, Smith GA, Thakkinstian A. Risk prediction score for death of traumatised and injured children. BMC Pediatr 2014;14:60.
  15. Kincaid EH, Chang MC, Letton RW, Chen JG, Meredith JW. Admission base deficit in pediatric trauma: A study using the National Trauma Data Bank. J Trauma 2001;51:332-5.
  16. Randolph LC, Takacs M, Davis KA. Resuscitation in the pediatric trauma population: Admission base deficit remains an important prognostic indicator. J Trauma 2002;53:838-42.
  17. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974;2:81-4.
  18. Marcoux KK. Management of increased intracranial pressure in the critically ill child with an acute neurological injury. AACN Clin Issues 2005;16:212-31.
  19. Gill MR, Reiley DG, Green SM. Interrater reliability of Glasgow Coma Scale scores in the emergency department. Ann Emerg Med 2004;43:215-23.
  20. Hess JR, Lindell AL, Stansbury LG, Dutton RP, Scalea TM. The prevalence of abnormal results of conventional coagulation tests on admission to a trauma center. Transfusion 2009;49:34-9.
  21. Verma A, Kole T. International normalized ratio as a predictor of mortality in trauma patients in India. World J Emerg Med 2014;5:192-5.
  22. Narci A, Solak O, Turhan-Haktanir N, Ayçiçek A, Demir Y, Ela Y, et al. The prognostic importance of trauma scoring systems in pediatric patients. Pediatr Surg Int 2009;25:25-30.
  23. Kaufmann CR, Maier RV, Rivara FP, Carrico CJ. Evaluation of the Pediatric Trauma Score. JAMA 1990;263:69-72.
  24. Eichelberger MR, Gotschall CS, Sacco WJ, Bowman LM, Mangubat EA, Lowenstein AD. A comparison of the trauma score, the revised trauma score, and the pediatric trauma score. Ann Emerg Med 1989;18:1053-8.
  25. Osler T, Baker SP, Long W. A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma 1997;43:922-5.
  26. Sullivan T, Haider A, DiRusso SM, Nealon P, Shaukat A, Slim M. Prediction of mortality in pediatric trauma patients: New injury severity score outperforms injury severity score in the severely injured. J Trauma 2003;55:1083-7.
  27. Brockamp T, Maegele M, Gaarder C, Goslings JC, Cohen MJ, Lefering R, et al. Comparison of the predictive performance of the BIG, TRISS, and PS09 score in an adult trauma population derived from multiple international trauma registries. Crit Care 2013;17:R134.
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