Novel Tool (BIS) Heralds the Need for Blood Transfusion and/or Failure of Non-operative Management in Pediatric Blunt Liver and Spleen Injuries

Background

Non-operative management (NOM) is the standard of care for the majority of children with blunt liver and spleen injuries (BLSI). The shock index pediatric age-adjusted (SIPA) was previously shown to predict the need for blood transfusions in pediatric trauma patients with BLSI. We combined SIPA with base deficit (BD) and International Normalized Ratio (INR) to create the BIS score. We hypothesized that the BIS score would predict the need for blood transfusions and/or failure of NOM in pediatric trauma patients with BLSI.

Methods

Patients (≤ 18 years) who presented to our Level I pediatric trauma center with BLSI from 2009-2019 were identified. BIS scores were calculated by giving 1 point for each of the following: base deficit ≤ -8.8, INR ≥ 1.5, or elevated SIPA. Receiver operating characteristic curves (ROC) were generated for BIS scores ≥ 1, ≥ 2, and ≥ 3. Area under the curve (AUC), sensitivity, and specificity of each score were calculated for ability to predict need for blood transfusions and/or failure of NOM.

Results

Of 477 children included, 19.9% required a blood transfusion and 6.7% failed NOM. A BIS score ≥1 was the best predictor of the need for blood transfusions with an AUC of 0.81 and a sensitivity of 96.0%. A BIS score ≥1 was also the best predictor of failure of NOM with an AUC of 0.72 and a sensitivity of 97.0%.

Conclusion

The BIS score is a highly sensitive tool that identifies pediatric patients with BLSI at risk for blood transfusions and/or failure of NOM.

Level of evidence

Level III

Type of study

Retrospective comparative study