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Ulgen Tekerek N, Cebisli E, Erkan M, Koker A, Dursun O. How significant is the BIG score in childhood traumatic brain injury? Childs Nerv Syst 2024; 40:1827-1831. [PMID: 38358429 DOI: 10.1007/s00381-024-06315-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/06/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND This study aims to evaluate the reliability of the BIG score in predicting mortality in children with traumatic brain injury (TBI) and to compare it with the literature and other scoring systems. METHODS Patients who were followed up in the Pediatric Intensive Care Unit (PICU) for TBI between 2014 and 2019 in a tertiary reference hospital were evaluated retrospectively. RESULTS One hundred fifty-nine patients met the inclusion criteria. The most common injury mechanisms were falling from a height (39.6%). The mortality rate was 12.6% (n = 20). The mean BIG score, ISS, and PRISM III were statistically significantly higher in the mortality group (p < 0.001). The AUC values found in the ROC analysis in the whole study group, respectively, 0.962 (CI 0.920-0.986) for the BIG score, 0.952 (CI 0.906-0.979) for the ISS, 0.957 (CI 0.913-0.983) for the GCS, and 0.981 (CI 0.946-0.996) for the PRISM III. In the patients with isolated TBI, the AUC value for the BIG score was 0.988 (0.967-1.000) and higher than the ISS and PRISM 3 [0.983 (0.956-1.000), 0.969 (0.932-1.000) respectively]). The cut-off point for the BIG score in the whole group was 19 (sensitivity 95%, specificity 88%, positive predictive value 0.58, negative predictive value 0.99). In logistic regression model, we found that BIG score is an independent variable for mortality (AOR:1.4, 95%CI 1.22-1.63). CONCLUSION In children with traumatic brain injury, the BIG score is simple, quickly calculated, and a good predictor of mortality and disease severity. Prospective studies with more extensive series are needed on this subject.
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Affiliation(s)
- Nazan Ulgen Tekerek
- Pediatric Intensive Care Unit, Faculty of Medicine, Department of Child Health and Diseases Secretariat, Akdeniz University, Akdeniz University Hospital, Dumlupınar Boulevard, Campus, H Block 2 Floor, 07070, Antalya, Turkey.
| | - Erdem Cebisli
- Pediatric Intensive Care Unit, Antalya Training, and Research Hospital, Antalya, Turkey
| | - Mine Erkan
- Department of Pediatrics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Alper Koker
- Pediatric Intensive Care Unit, Akdeniz University School of Medicine, Antalya, Turkey
| | - Oguz Dursun
- Pediatric Intensive Care Unit, Akdeniz University School of Medicine, Antalya, Turkey
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Çeleğen M, Çeleğen K. Lactate Clearance as an Early Prognostic Marker of Mortality for Pediatric Trauma. KLINISCHE PADIATRIE 2023; 235:270-276. [PMID: 36379454 DOI: 10.1055/a-1829-6305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background While lactate clearance (LC) has already been shown as a prognostic indicator in clinical studies, its certain character needs to be defined in pediatric trauma. This research aimed to evaluate the correlation between early lactate clearance and mortality in pediatric trauma.Patients and methods A retrospective cohort study was conducted in a university hospital. Repeated LC was measured at admission, at the 2nd, 6th, and 12th hours post-admission. The association of lactate clearance with mortality was analyzed and using receiver operating characteristic (ROC) to determine the threshold levels of lactate clearance and also logistic regression analysis was performed to determine whether LC was an independent risk factor.Results Seventy-eight patients were included and overall mortality was 13%. LC values of the non-survivors was significantly lower than survivors for LC0-2 h (28.60±14.26 vs 4.64±15.90), LC0-6 h (46.63±15.23 vs 3.33±18.07), LC0-12 h (56.97±15.53 vs 4.82±22.59) (p:<0.001, p:<0.001 and p:<0.001, respectively). Areas under the curve of lactate clearance at the 2nd, 6th, and 12th hours after therapy start were a significant predictor for mortality (p:<0.001, p:<0.001, and p:<0.001, respectively). Threshold values of LC were 12.9, 19.5 and 29.3%, respectively.Conclusion Lactate clearance was a beneficial tool to estimate outcomes of pediatric trauma. Poor lactate clearance was a significant marker for poor prognosis.
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Affiliation(s)
- Mehmet Çeleğen
- Department of Pediatrics, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Kübra Çeleğen
- Division of Pediatric Nephrology, Department of Pediatrics, Afyonkarahisar Health Sciences University Faculty of Medicine, Afyonkarahisar, Turkey
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Abbas Q, Zeeshan A, Jawwad M, Moazzam M, Yousafzai M. BIG score and its comparison with different scoring systems for mortality prediction in children with severe traumatic brain injury admitted in pediatric intensive care unit. J Pediatr Neurosci 2023. [DOI: 10.4103/jpn.jpn_16_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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De los Ríos-Pérez A, García A, Cuello L, Rebolledo S, Fandiño-Losada A. Performance of the Paediatric Trauma Score on survival prediction of injured children at a major trauma centre: A retrospective Colombian cohort, 2011-2019. LANCET REGIONAL HEALTH. AMERICAS 2022; 13:100312. [PMID: 36777320 PMCID: PMC9903890 DOI: 10.1016/j.lana.2022.100312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Despite improvements in children's health due to a reduction in infections, trauma continues to cause many deaths among adolescents. Strategies to mitigate morbidity and mortality from trauma include severity scores to classify and refer patients to the appropriate hospitals to provide better management; however, these strategies have not been assessed in Colombian children. This study aimed to describe the characteristics and outcomes of injured children and evaluate the performance of the Pediatric Trauma Score (PTS) in predicting survival at a major trauma centre in a Colombian city. Methods This was a retrospective cohort study of children aged <18 years who were treated for injuries at a hospital in Colombia. The primary outcome was 30-day mortality. A simple logistic regression model was used with PTS as the predictor variable and vital status at discharge as the outcome variable. PTS performance was assessed by discrimination using the area under the receiver-operating characteristic (AUROC) curve and by calibration using the Hosmer-Lemeshow (HL) goodness-of-fit test. Findings A total of 1047 children were admitted. The median age was 12 years (interquartile range [IQR]=5-15); 73·7% were male, and 66·1% had blunt trauma. The most frequent cause of injury was traffic accident (31·5%) followed by assaults (29%). Mortality was 5·9%; 61·3% of these deaths occurred in adolescents between 15 and 17 years of age and 71% of deaths in this age group were due to injuries from a firearm. The PTS had a median of 7 (IQR=5-9), an AUROC of 0·93, and good calibration (HL=7·97, p = 0·33). Interpretation The highest proportion of trauma and death occurred among adolescents. Interpersonal violence was the most frequent cause of death in this age group. The PTS showed good predictive power for survival, with excellent discrimination and good calibration. Funding None.
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Affiliation(s)
- Ana De los Ríos-Pérez
- Program in Methodology of Biomedical Research and Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundación Valle del Lili University Hospital, Cali, Colombia
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
- Corresponding author.
| | - Alberto García
- Fundación Valle del Lili University Hospital, Cali, Colombia
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
- Faculty of Health, Universidad del Valle, Cali, Colombia
- Cisalva Institute, Faculty of Health, Universidad del Valle, Cali, Colombia
| | - Laura Cuello
- Fundación Valle del Lili University Hospital, Cali, Colombia
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
| | - Sara Rebolledo
- Fundación Valle del Lili University Hospital, Cali, Colombia
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
| | - Andrés Fandiño-Losada
- Faculty of Health, Universidad del Valle, Cali, Colombia
- Cisalva Institute, Faculty of Health, Universidad del Valle, Cali, Colombia
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Ko Y, Kim JH, Hwang K, Lee J, Huh Y. Comparison of Base Deficit and Vital Signs as Criteria for Hemorrhagic Shock Classification in Children with Trauma. Yonsei Med J 2021; 62:352-358. [PMID: 33779089 PMCID: PMC8007427 DOI: 10.3349/ymj.2021.62.4.352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/01/2021] [Accepted: 02/05/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Base deficit (BD) is superior to vital signs in predicting trauma outcomes in adults. The authors aimed to compare BD and vital signs as criteria for the four-tiered hemorrhagic shock classification in children with trauma. MATERIALS AND METHODS We retrospectively reviewed the data of 1046 injured children who visited a Korean academic hospital from 2010 through 2018. These children were classified separately based on BD (class I, BD ≤2.0 mmol/L; II, 2.1-6.0 mmol/L; III, 6.1-10 mmol/L; and IV, ≥10.1 mmol/L) and vital signs (<13 years: age-adjusted hypotension and tachycardia, and Glasgow Coma Scale; 13-17 years: the 2012 Advanced Trauma Life Support classification). The two methods were compared on a class-by-class basis regarding the outcomes: mortality, early transfusion (overall and massive), and early surgical interventions for the torso or major vessels. RESULTS In total, 603 children were enrolled, of whom 6.6% died. With the worsening of BD and vital signs, the outcome rates increased stepwise (most p<0.001; only between surgical interventions and vital signs, p=0.035). Mortality more commonly occurred in BD-based class IV than in vital signs-based class IV (58.8% vs. 32.7%, p=0.008). Early transfusion was more commonly performed in BD-based class III than in vital signs-based class III (overall, 73.8% vs. 53.7%, p=0.007; massive, 37.5% vs. 15.8%, p=0.001). No significant differences were found in the rates of early surgical interventions between the two methods. CONCLUSION BD can be a better predictor of outcomes than vital signs in children with severe hemorrhagic shock.
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Affiliation(s)
- Yura Ko
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Jung Heon Kim
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Kyungjin Hwang
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Jisook Lee
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Yo Huh
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
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Huh Y, Ko Y, Hwang K, Jung K, Cha YH, Choi YJ, Lee J, Kim JH. Admission Lactate and Base Deficit in Predicting Outcomes of Pediatric Trauma. Shock 2021; 55:495-500. [PMID: 32890310 DOI: 10.1097/shk.0000000000001652] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To compare admission lactate and base deficit (BD), which physiologically reflect early hemorrhagic shock, as outcome predictors of pediatric trauma. METHODS We reviewed the data of children with trauma who visited a Korean academic hospital from 2010 through 2018. Admission lactate and BD were compared between children with and without primary outcomes. The outcomes included in-hospital mortality, early (≤24 h) transfusion, and early surgical interventions for the torso or major vessels. Subsequently, performances of lactate and BD in predicting the outcomes were compared using receiver operating characteristic curves. Logistic regressions were conducted to identify the independent associations of the two markers with each outcome. RESULTS Of the 545 enrolled children, the mortality, transfusion, and surgical interventions occurred in 7.0%, 43.5%, and 14.9%, respectively. Cutoffs of lactate and BD for each outcome were as follows: mortality, 5.1 and 6.7 mmol/L; transfusion, 3.2 and 4.9 mmol/L; and surgical interventions, 2.9 and 5.2 mmol/L, respectively. No significant differences were found in the areas under the curve for each outcome. Of the two markers, a lactate of >5.1 mmol/L was associated with mortality (adjusted odds ratio, 6.43; 95% confidence interval, 2.61-15.84). A lactate of >3.2 mmol/L (2.82; 1.65-4.83) and a BD of >4.9 mmol/L (2.32; 1.32-4.10) were associated with transfusion, while only a BD of >5.2 mmol/L (2.17; 1.26-3.75) was done with surgical interventions. CONCLUSIONS In pediatric trauma, lactate is more strongly associated with mortality. In contrast, BD may have a marginally stronger association with the need for hemorrhage-related procedures.
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Affiliation(s)
- Yo Huh
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Yura Ko
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Kyungjin Hwang
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Kyoungwon Jung
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Yoon-Ho Cha
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Yoo Jin Choi
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Jisook Lee
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Jung Heon Kim
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
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