Big Score (Base Deficit INR, GCS) as a Mortality Predicting Score in Adult Patients with Multiple Trauma within 24HRS of Injury up to 30 Days of Mortality

Abstract: Background: Several scoring models have been developed for assessment of traumatic injury extent. One of these trauma scoring systems, the BIG score has popularity because of its simplicity and time constraints. Objective: To analyze the predictive ability of BIG score in identifying in-hospital mortality among multiple trauma patients presenting to emergency room (ER) in a tertiary care hospital. Materials and Methods: This prospective observational investigation was executed by emergency department at Liaquat National Hospital during 1st April, 2022 to 31st December, 2022, after obtaining approval from ethical review committee of Liaquat National Hospital (IRB# 0736-2022-LNH-ERC). Patients presenting with multiple trauma were evaluated for BIG score upon their arrival to emergency room. Patients were kept under follow-up until their discharge or in-hospital mortality. Result: Altogether 169 patients were studied with mean age of 27 ± 7 years. In-hospital mortality was seen in 75% of patients. GCS score on ER presentation (p<0.001) was substantially lesser and BIG score (p<0.001) was significantly higher among dead patients and as compared to survivors. Frequency of diabetes (p=0.020), hypertension (p=0.016), ischemic heart disease (p=0.025), intubation upon ER arrival (p<0.001) and blunt trauma was significantly higher among those who had in-hospital than patients who were discharged safely. AUC for BIG score was 0.877. Youden index is 18.5. At threshold of 18.5, sensitivity and specificity was 81% and 76.7% respectively. On multivariable analysis, BIG score was found to be independent predictor of in-hospital mortality. Conclusion: The present study demonstrated the good predictive value of BIG score in classifying the high risk patients for in-hospital among multiple trauma patients presenting to emergency room. Keywords: In-hospital mortality, Blunt trauma, Penetrating trauma, BIG score, Emergency room, GCS score.