ORIGINAL ARTICLE Admission Base Deficit as a Long-Term Prognostic Factor in Severe Pediatric Trauma Patients Cle ´mence Hindy-Franc ¸ois, MD, Philippe Meyer, MD, Ste ´phane Blanot, MD, Sophie Marque ´, MD, Nada Sabourdin, MD, Pierre Carli, MD, and Gilles Orliaguet, MD, PhD 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 univar- iate 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 anal- ysis, 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. Key Words: Children, Trauma, Base deficit, Outcome. (J Trauma. 2009;67: 1272–1277) I n developed countries, trauma is the main cause of death and morbidity in children older than 1 year. 1,2 As a result, early prediction of outcome is important to provide adequate triage and critical care management, and to deliver precise information to the parents. Severe trauma patients may present with shock on hospital admission. From the cellular point of view, shock represents a situation where oxygen delivery is insufficient, because of inadequate blood supply, or as a consequence of poor tissue oxygen extraction. Shock leads to anaerobic metabolism with lactic acidosis and bicarbonate buffer con- sumption. Base deficit (BD) has been described since 1960 by Anderson and Engel 3 . It is a simple measure of the metabolic acid-base activity and is defined by the amount of strong acid or base required to return the pH of 1 L of whole blood to 7.4, assuming a PCO 2 of 40 mm Hg and a temperature of 37°. It does not quantify acid-base disorder of respiratory origin. Shock leads to metabolic acidosis and increased BD. In children, heart rate and arterial blood pressure poorly reflect the severity of shock because of very effective com- pensatory physiologic mechanisms. Moreover, normal values for heart rate and blood pressure vary over a wide range in children, making interpretation of any modifications more difficult than in adults. In adult trauma patients, BD has become an important prognostic tool and correlates with trauma scores, 4 transfusion requirement, 5 morbidity, 6 and mortality. 4 Nevertheless, these correlations cannot be extrap- olated to traumatized children because of the physiologic differences between adults and children. Specific pediatric scores 7–9 exist to predict the risk of mortality in pediatric intensive care units but prove to be difficult to calculate as they take into account many variables and are not specific to trauma patients. The BD appears in the pediatric index of mortality score formula 8 . To date, three retrospective Amer- ican 10 –12 studies have shown that an admission BD more than 8 mmol/L was significantly associated with an increased risk of mortality in pediatric trauma patients. In France, trauma patients, including pediatric patients, are dealt with by phy- sicians 13 in the field and not by paramedics 14 . Patients are susceptible to receive more aggressive care that could change the prognosis threshold associated with BD. We designed a prospective study to evaluate the prognostic value of admis- sion BD in French traumatized children. We hypothesized that an increased BD would correlate with a poorer outcome. MATERIALS AND METHODS The study was approved by the ethics committee (Co- mite ´ Consultatif de Protection des Personnes dans la Recher- che Biome ´dicale, CCPPRB, ho ˆpital de la Pitie ´ Salpe ˆtrie `re, Assistance Publique des Ho ˆpitaux de Paris, Paris, France). Waived parental informed consent was authorized as patients were treated according to a routine protocol used in our department without any additional intervention. Confidenti- Submitted for publication June 12, 2008. Accepted for publication January 22, 2009. Copyright © 2009 by Lippincott Williams & Wilkins Service d’Anesthe ´sie Re ´animation (P.M., S.B., N.S., P.C., G.O.), Ho ˆpital Necker- Enfants Malades (C.H.-F.), APHP-Universite ´ Paris Descartes, Paris; and Service de re ´animation me ´dicale (S.M.), Ho ˆpital Pontchaillou, Rennes, France. Address for reprints: Gilles Orliaguet, MD, PhD, Service d’Anesthe ´sie Re ´anima- tion, Ho ˆpital Necker-Enfants Malades, 149, rue de SEVRES, APHP, Univer- site ´ Paris Descartes, 75743 Paris Cedex 15. France; email: gilles.orliaguet@nck. aphp.fr. DOI: 10.1097/TA.0b013e31819db828 1272 The Journal of TRAUMA ® Injury, Infection, and Critical Care • Volume 67, Number 6, December 2009