Resuscitation in the pediatric trauma population: admission base deficit remains an important prognostic indicator.

BACKGROUND

Base deficit (BD), as an endpoint for trauma resuscitation, has been extensively studied in the adult trauma patient but not in the pediatric population. We proposed that admission BD would correlate with outcomes after trauma in a pediatric population.

METHODS

This study was a retrospective review of all patients admitted to the pediatric intensive care unit in an adult trauma center with pediatric commitment in whom an admission BD was available, over the 5-year period ending June 2001.

RESULTS

A total of 65 patients formed the study population. Overall mortality was 20%. Patients who died were younger (6 +/- 5 vs. 9 +/- 5 years; p = 0.009), had lower Glasgow Coma Scale scores at admission (7 +/- 5 vs. 10 +/- 5; p < 0.0001), had higher Injury Severity Scores (24 +/- 14 vs. 14 +/- 9; p < 0.0001), and had lower Pediatric Trauma Scores (7 +/- 4 vs. 10 +/- 2; p < 0.0001). No patient with a BD less negative than -5 died, whereas 13 of 37 patients with a BD of -5 or higher died (37%) (p < 0.0001). Of the 13 patients who died, 8 never cleared their BD and died within 33 +/- 18 hours of admission. Failure to clear BD was associated with 100% mortality. Five patients who normalized their BD died of isolated closed head injuries (time to death, 37 +/- 18 hours; p = not significant). All surviving patients normalized their BD within 43 +/- 41 hours of admission. Seventy-five percent of patients who survived (39 of 52) had a normal BD within 48 hours of admission.

CONCLUSION

Admission BD in the pediatric trauma patient is a strong indicator of posttraumatic shock. An admission BD of < or = -5 is predictive of severe injury and of poor outcome, with a 37% mortality in this series. Failure to clear BD is an extremely poor prognostic indicator.