A.M. Wong1, P. McGillen1, M. Martin1 1Keck School of Medicine of USC, Trauma Surgery, Los Angeles, CA, USA
Introduction: Determining medical management of traumatic brain injuries (TBI) is time-sensitive, with up to 70% of early deaths due to withdrawal of care. However, estimates show 26% of these patients could have survived, with a majority making a good recovery, and subjectivity during prognostication can prevent patients from receiving full intensive care. Therefore, a reliable prognostic indicator would be useful for early decision making. We sought to determine the association between the Base Deficit, INR, and Glasgow Coma Scale (BIG) score and functional outcomes within one-year post-injury.
Methods: A meta-analysis was conducted using the Federal Interagency Traumatic Brain Injury Research (FITBIR) Informatics System, a national database of TBI studies. Two multicenter prospective studies were selected with data collected from 2006-2018. Patients 18 years or older were subsequently categorized on whether they had a BIG score >8 24 hours after admission and a Glasgow Outcome Scale Extended (GOS-E) <5 one year post-injury. Multivariate logistic regressions yielded odds ratios and 95% confidence intervals.
Results: A total of 329 TBI patients were identified with BIG scores. 147 patients (44.7%) had a GOS-E <5 while 182 patients (55.3%) had a GOS-E ≥5. The median age was 39 in patients with a GOS-E <5 and 31 with a GOS-E ≥5 (p<0.001). Median injury severity scores in patients with a GOS-E <5 was 28 and 25 in those with a GOS-E ≥5 (p<0.001). The median best BIG score at 24 hours was 13.0 for patients with a GOS-E <5 and 6.8 for those with a GOS-E ≥5 (p<0.001). All three components of the BIG score were each significantly associated with worse functional outcomes (Table 1). In a multivariate analysis, having a BIG score >8 predicted whether a patient would experience poor functional outcomes within one year (GOS-E <5) (OR=3.7, p<0.001). Compared to GCS alone, the BIG score had a greater sensitivity of 81.0% compared to 76.2% for GCS. The BIG score and GCS had a similar NPV as well at 79.1% and 79.4%, respectively.
Conclusion: The BIG score is a promising and easily calculated prognostic tool to predict short-term functional outcome in patients presenting with TBI. It has a greater ability than GCS to identify patients that may have poor functionality and is comparable in discriminating between good and poor functional outcomes.