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Admission Base Deficit as a Long-Term Prognostic Factor in Severe Pediatric Trauma Patients

Hindy-François, Clémence MD; Meyer, Philippe MD; Blanot, Stéphane MD; Marqué, Sophie MD; Sabourdin, Nada MD; Carli, Pierre MD; Orliaguet, Gilles MD, PhD

Journal of Trauma-Injury Infection & Critical Care:
doi: 10.1097/TA.0b013e31819db828
Original Article
Abstract

Background: Base deficit (BD) is a prognostic tool that correlates with trauma scores and mortality in adult trauma patients. Retrospective studies have shown that admission BD more than 8 mmol/L is associated with an increased risk of mortality. This is the first prospective European study aimed at evaluating the prognostic value of admission BD in traumatized children.

Methods: One hundred severely traumatized children were included if an arterial BD had been calculated on arrival in the trauma room of a university hospital. Epidemiologic, medical, and biological data (including admission BD and lactates concentration) were recorded and compared using a univariate analysis. The primary endpoint was in-hospital mortality. Secondary endpoints were outcome on discharge and at 6 months. Cutoff values for BD or lactates regarding outcomes were determined using receiver operating characteristic curves if these data had been isolated on multivariate analysis (p < 0.05).

Results: Sixty-eight boys and 32 girls, aged 6.7 years, were enrolled from March 2003 to December 2005, mainly after road traffic accidents. Twenty-two died at the hospital, 34 children and 51 children were classified as having a good outcome on hospital discharge and 6 months later, respectively. After the multivariate procedure and receiver operating characteristic curve analysis, admission lactates more than 2.94 mmol/L and admission BD more than 5 mEq/L were independent risk factors for mortality (odds ratio 2.4 [95% confidence interval 1.3–4.6]) and poor outcome at 6 months (odds ratio 2.5 [95% confidence interval 1.13–5.5]), respectively.

Discussion: BD could be used to predict the long-term morbidity and may not be related to morbidity and mortality at discharge.

Author Information

Service d'Anesthésie Réanimation (P.M., S.B., N.S., P.C., G.O.), Hôpital Necker-Enfants Malades (C.H.-F.), APHP-Université Paris Descartes, Paris; and Service de réanimation médicale (S.M.), Hôpital Pontchaillou, Rennes, France.

Submitted for publication June 12, 2008.

Accepted for publication January 22, 2009.

Address for reprints: Gilles Orliaguet, MD, PhD, Service d'Anesthésie Réanimation, Hôpital Necker-Enfants Malades, 149, rue de SEVRES, APHP, Université Paris Descartes, 75743 Paris Cedex 15. France; email: gilles.orliaguet@nck.aphp.fr.

© 2009 Lippincott Williams & Wilkins, Inc.