• Jeff Bolstridge, Erika R O'Neil, James K Aden, Teddy Muisyo, Philip C Spinella, and Matthew A Borgman.
• Brooke Army Medical Center, Department of Pediatrics, MCHE-ZDP, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234, United States of America. Electronic address: jeffrey.m.bolstridge.mil@mail.mil.
• Am J Emerg Med. 2021 Jul 1; 45: 472-475.

ObjectiveThe BIG score, which is comprised of admission base deficit (B), International Normalized Ratio (I), and GCS (G), is a severity of illness score that can be used to rapidly predict in-hospital mortality in pediatric patients presenting following traumatic injury. We sought to compare the mortality prediction of the pediatric trauma BIG score with other well-established pediatric trauma severity of illness scores: the pediatric logistic organ dysfunction (PELOD); the pediatric index of mortality 2 (PIM2); and the pediatric risk of mortality (PRISM III).MethodsIn this retrospective cohort study, data from 2009 to 2015 was collected using a multi-institutional database. All pediatric patients admitted following traumatic injury with a recorded initial GCS were included. BIG, PELOD, PIM2, and PRISM III scores were calculated, and Receiver Operator Characteristic curves were derived for all severity of illness scores. Mortality prediction performance for each score was compared by the area under the curve (AUC).ResultsA total of 29,204 patients were included in this analysis. AUC for BIG, PELOD, PIM2, and PRISM III scores were 0.97 (0.97-0.98), 0.98 (0.98-0.98), 0.98 (0.97-0.98), and 0.99 (0.98-0.99), respectively. At the optimum cut-off point of 16, the BIG score had a sensitivity of 0.937, specificity of 0.938, positive predictive value of 0.514, and negative predictive value of 0.995.ConclusionsIn this massive cohort of pediatric trauma patients, the BIG score using imputation of missing variables performed similarly to the PELOD, PIM2, and PRISM III, further validating the score as a predictor of mortality.Published by Elsevier Inc.

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