Özel Abdulrahman, Yüce Servet, Şengenç Esma, İlbeği Esra Nur, Kaya İzzettin, Gazneli Şevval Özyılmaz, Erol Meltem
Pediatric Intensive Care Unit, Department of Pediatrics, Bağcılar Training and Research Hospital, University of Health Sciences Türkiye, Merkez District, Dr. Sadık Ahmet Street. No:5, 34200, Istanbul, Türkiye.
Department of Public Health, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye.
Childs Nerv Syst. 2025 Apr 1;41(1):147. doi: 10.1007/s00381-025-06809-1.
This study aimed to evaluate the prognostic value of the BIG score in predicting mortality and functional outcomes in pediatric patients with traumatic brain injury (TBI).
A retrospective analysis was conducted on pediatric TBI patients admitted to the Pediatric Intensive Care Unit (PICU) between 2020 and 2024 at a tertiary hospital. Functional outcomes at discharge were assessed using the Functional Status Scale (FSS). Receiver operating characteristic (ROC) analysis determined the predictive accuracy of the BIG score, Pediatric Trauma Score (PTS), Pediatric Glasgow Coma Scale (pGCS), and Pediatric Risk of Mortality III (PRISM III).
A total of 103 patients were included. The mortality rate was 13.6% (n = 14), and 21.4% of survivors had functional impairment at discharge. In non-survivors, the BIG score, PTS, pGCS, and PRISM III were significantly elevated (all p < 0.001). The AUC for predicting mortality was 0.966 (BIG score), 0.911 (PRISM III), 0.909 (pGCS), and 0.827 (PTS). For functional impairment, the AUC values were 0.815 (BIG score), 0.812 (pGCS), 0.715 (PRISM III), and 0.645 (PTS). Correlation analysis showed a strong association between FSS scores and mechanical ventilation duration (r = 0.786, p < 0.001) and PICU length of stay (r = 0.706, p < 0.001).
The BIG score is a rapid, reliable predictor of mortality and functional outcomes in pediatric TBI patients, outperforming pGCS in patients with an initial pGCS of 3. Prospective studies are needed for further validation.
本研究旨在评估BIG评分在预测小儿创伤性脑损伤（TBI）患者死亡率和功能结局方面的预后价值。
对一家三级医院2020年至2024年期间入住儿科重症监护病房（PICU）的小儿TBI患者进行回顾性分析。出院时的功能结局采用功能状态量表（FSS）进行评估。受试者工作特征（ROC）分析确定了BIG评分、小儿创伤评分（PTS）、小儿格拉斯哥昏迷量表（pGCS）和小儿死亡风险Ⅲ（PRISMⅢ）的预测准确性。
共纳入103例患者。死亡率为13.6%（n = 14），21.4%的幸存者出院时存在功能障碍。在非幸存者中，BIG评分、PTS、pGCS和PRISMⅢ显著升高（均p < 0.001）。预测死亡率的AUC分别为0.966（BIG评分）、0.911（PRISMⅢ）、0.909（pGCS）和0.827（PTS）。对于功能障碍，AUC值分别为0.815（BIG评分）、0.812（pGCS）、0.715（PRISMⅢ）和0.645（PTS）。相关性分析显示FSS评分与机械通气时间（r = 0.786，p < 0.001）和PICU住院时间（r = 0.706，p < 0.001）之间存在强关联。
BIG评分是小儿TBI患者死亡率和功能结局的快速、可靠预测指标，在初始pGCS为3分的患者中优于pGCS。需要进行前瞻性研究以进一步验证。
