Division of Pediatric Emergency Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada.
Research Institute, Hospital for Sick Children, Toronto, ON, Canada.
Pediatr Crit Care Med. 2019 Oct;20(10):970-979. doi: 10.1097/PCC.0000000000002050.
To examine the association of the base deficit, international normalized ratio, and Glasgow Coma Scale (BIG) score on emergency department arrival with functional dependence at hospital discharge (Pediatric Cerebral Performance Category ≥ 4) in pediatric multiple trauma patients with traumatic brain injury.
A retrospective cohort study of a pediatric trauma database from 2001 to 2018.
Level 1 trauma program at a university-affiliated pediatric institution.
Two to 17 years old children sustaining major blunt trauma including a traumatic brain injury and meeting trauma team activation criteria.
None.
Two investigators, blinded to the BIG score, determined discharge Pediatric Cerebral Performance Category scores. The BIG score was measured on emergency department arrival. The 609 study patients were 9.7 ± 4.4 years old with a median Injury Severity Score 22 (interquartile range, 12). One-hundred seventy-one of 609 (28%) had Pediatric Cerebral Performance Category greater than or equal to 4 (primary outcome). The BIG constituted a multivariable predictor of Pediatric Cerebral Performance Category greater than or equal to 4 (odds ratio, 2.39; 95% CI, 1.81-3.15) after adjustment for neurosurgery requirement (odds ratio, 2.83; 95% CI, 1.69-4.74), pupils fixed and dilated (odds ratio, 3.1; 95% CI, 1.49-6.38), and intubation at the scene or referral hospital (odds ratio, 2.82; 95% CI, 1.35-5.87) and other postulated predictors of poor outcome. The area under the BIG receiver operating characteristic curve was 0.87 (0.84-0.90). Using an optimal BIG cutoff less than or equal to 8, sensitivity and negative predictive value for functional dependence at discharge were 93% and 96%, respectively, compared with a sensitivity of 79% and negative predictive value of 91% with Glasgow Coma Scale less than or equal to 8. In children with Glasgow Coma Scale 3, the BIG score was associated with brain death (odds ratio, 2.13; 95% CI, 1.58-2.36). The BIG also predicted disposition to inpatient rehabilitation (odds ratio, 2.26; 95% CI, 2.17-2.35).
The BIG score is a simple, rapidly obtainable severity of illness score that constitutes an independent predictor of functional dependence at hospital discharge in pediatric trauma patients with traumatic brain injury. The BIG score may benefit Trauma and Neurocritical care programs in identifying ideal candidates for traumatic brain injury trials within the therapeutic window of treatment.
探讨创伤性脑损伤的儿科多发创伤患者到达急诊时的基础缺陷、国际标准化比值和格拉斯哥昏迷量表（BIG）评分与住院期间功能依赖（儿童脑功能预后类别≥4）之间的关系。
对 2001 年至 2018 年期间儿科创伤数据库的回顾性队列研究。
大学附属儿科机构的 1 级创伤项目。
2 至 17 岁的儿童，有主要的钝性创伤，包括创伤性脑损伤，并符合创伤小组激活标准。
无。
两名研究人员对 BIG 评分不知情，确定了出院时的儿童脑功能预后类别评分。BIG 评分在急诊时测量。609 名研究患者的年龄为 9.7±4.4 岁，中位数损伤严重程度评分 22（四分位距 12）。609 例中有 171 例（28%）的儿童脑功能预后类别大于或等于 4（主要结局）。在调整神经外科需求（比值比，2.83；95%可信区间，1.69-4.74）、瞳孔固定和散大（比值比，3.1；95%可信区间，1.49-6.38）、现场或转诊医院插管（比值比，2.82；95%可信区间，1.35-5.87）以及其他假定的不良预后预测因素后，BIG 构成了儿童脑功能预后类别大于或等于 4 的多变量预测因素（比值比，2.39；95%可信区间，1.81-3.15）。BIG 的接收器工作特征曲线下面积为 0.87（0.84-0.90）。使用小于或等于 8 的最佳 BIG 截断值，出院时功能依赖的灵敏度和阴性预测值分别为 93%和 96%，而格拉斯哥昏迷量表小于或等于 8 的灵敏度和阴性预测值分别为 79%和 91%。在格拉斯哥昏迷量表 3 分的儿童中，BIG 评分与脑死亡相关（比值比，2.13；95%可信区间，1.58-2.36）。BIG 还预测了住院康复治疗的情况（比值比，2.26；95%可信区间，2.17-2.35）。
BIG 评分是一种简单、快速获得的疾病严重程度评分，是创伤性脑损伤的儿科多发创伤患者住院期间功能依赖的独立预测因素。BIG 评分可能使创伤和神经危重病学计划受益，以便在治疗窗口期内确定创伤性脑损伤试验的理想候选者。
