Institutional members access full text with Ovid®

Share this article on:

Base Deficit-Based Predictive Modeling of Outcome in Trauma Patients Admitted to Intensive Care Units in Dutch Trauma Centers

Kroezen, Frank MD; Bijlsma, Taco S. MD, PhD; Liem, Mike S. L. MD, PhD; Meeuwis, J Dik MD, PhD, FACS; Leenen, Luke P. H. MD, PhD, FACS

Journal of Trauma-Injury Infection & Critical Care: October 2007 - Volume 63 - Issue 4 - pp 908-913
doi: 10.1097/TA.0b013e318151ff22
Original Articles

Background: Worldwide, the base deficit is available as an objective indicator of acid base status. We used the base deficit as a measure of physiologic derangement in a Trauma and Injury Severity Score (TRISS)-like model as a predictor for outcome in trauma patients.

Methods: We prospectively recorded data of 349 consecutive trauma patients admitted to the intensive care unit and calculated Revised Trauma Score, Injury Severity Score and Abbreviated Injury Scale, and TRISS and correlated them with the simultaneously determined base deficit value. The delta base deficit is introduced, which is the absolute difference of the base deficit from its normal range (−2 to 2). A statistical model analogous to the TRISS model was designed in which the physiologic disturbance reflected by the Revised Trauma Score was replaced by the delta base deficit [Base Excess Injury Severity Scale (BISS) model]. Calculating the area under the curve (AUC) of the respective receiver operating characteristic curve compared these two models. Finally, the BISS model was validated in a patient group from another tertiary referral hospital in which similar data were recorded prospectively.

Results: We demonstrated a significant correlation between the delta base deficit and the calculated trauma scoring systems. Moreover, the delta base deficit is significantly correlated with mortality. The BISS performed better than the TRISS did when evaluated by the AUC of the receiver operating characteristic curves (AUC 0.806 vs. 0.803, respectively). Validation in an independent prospectively compiled dataset from another referral center showed comparable and even better results (AUC 0.891 vs. 0.885, respectively).

Conclusions: The performance of our proposed BISS model was superior to that of the TRISS model in the populations under investigation. Nevertheless, given the ease of assessment and the objective value of the base deficit, it may be considered as a good method to predict outcome and evaluate care of trauma patients. Whether this can be translated to trauma patients in general needs further investigation.

From the Department of Surgery (F.K., J.D.M.), St. Elisabeth Hospital, Tilburg; and Department of Surgery (T.S.B., M.S.L.L., L.P.H.L.), University Medical Center, Utrecht, The Netherlands.

Submitted for publication May 21, 2004.

Accepted for publication June 19, 2007.

Address for reprints: L. P. H. Leenen, MD, PhD, FACS, Department of Surgery, UMC Utrecht, Heidelberglaan 100, Utrecht, The Netherlands; email: lleenen@umcutrecht.nl.

© 2007 Lippincott Williams & Wilkins, Inc.