Predicting mortality in adults hospitalized with multiple trauma: Can the BIG score estimate risk?

Abstract

Background: This study aimed to compare the predictive performance of the BIG score (base deficit + [2.5 × international normalized ratio (INR)] + [15 - Glasgow Coma Scale (GCS)]) for in-hospital mortality in adult patients with multiple trauma against other scoring systems, including the Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and Injury Severity Score (ISS).

Methods: A retrospective single-center study was conducted, including 563 adults (aged ≥18 years) with multiple trauma who were admitted to the emergency department and hospitalized between January 2022 and December 2023. Demographic and clinical characteristics, as well as trauma scoring systems (e.g., GCS, RTS, ISS, and BIG score), were analyzed between survivors and nonsurvivors to identify factors associated with in-hospital mortality.

Results: The BIG score, along with the RTS and ISS, was identified as an independent predictor of mortality in adults with multiple trauma (p<0.001 for all comparisons). A BIG score of 10.65 was determined as the mortality cut-off, with 67.7% sensitivity and 86.5% specificity (area under the curve: 0.847; 95% confidence interval: 0.808-0.886). The BIG score demonstrated higher positive predictive value (60.8%) and negative predictive value (89.6%) compared to the other trauma scoring systems. Estimated mortality risks for BIG scores of 15 and 20 were 50% and 80%, respectively.

Conclusion: The BIG score can accurately predict in-hospital mortality in adults with multiple trauma. Additionally, the BIG score was superior to the GCS, RTS, and ISS in predicting in-hospital mortality (ClinicalTrials.gov identifier: NCT06574464).