Original Contributions BASE EXCESS AS A PREDICTOR FOR INJURY SEVERITY IN PEDIATRIC TRAUMA PATIENTS Yochai Levi, MD,*† Igor Jeroukhimov, MD,‡ Kobi Peleg, PHD,†§ Michael Rozenfeld, MA,§ Itai Shavit, MD,k and Eran Kozer, MD*† *Pediatric Emergency Unit, Assaf Harofeh Medical Center, Zerifin, Israel, †Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel, ‡Trauma Unit, Assaf Harofeh Medical Center, Zerifin, Israel, §National Center for Trauma & Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel, and kPediatric Emergency Unit, Meyer’s Children’s Hospital, Rambam, Haifa, Israel Reprint Address: Eran Kozer, MD, Pediatric Emergency Unit, Assaf Harofeh Medical Center, Zerifin 70300, Israel , Abstract—Background: Base excess is considered a pre- dictor of mortality and severity of injury in trauma patients. Base excess had been widely examined in different settings. Only few studies have examined the role of base excess in pediatric trauma patients. Objective: To evaluate the value of admission base excess in pediatric trauma patients with respect to intensive care unit (ICU) admission rate and length of hospital stay. Methods: A retrospective study of pe- diatric trauma patients was conducted at a Level II trauma center. All patients aged 0–16 years for which a trauma team was activated over the years 2006–2009 were included. Study database included admission base excess, mechanism of injury, location and nature of injury, injury severity score, length of hospital stay, and ICU admission. Results: The study group consisted of 359 patients. There was a weak linear correlation between admission base excess, length of stay in the hospital, and ICU admission. Base excess seemed to show a stronger correlation for the youngest age group (0–6 years) and no correlation for the middle age group. There was a positive but weak correlation (R Spearman = 0.26) between admission base excess and Injury Severity Score (ISS). However, 40% of the children with an ISS score >25 had normal admission base excess values. The area un- der the curve of the receiver operating characteristic curves of base excess for predicting ICU admission was 0.66. Conclusions: The admission base excess in pediatric trauma patients seems to be a weak prognostic factor in our facility. Ó 2013 Elsevier Inc. , Keywords—base excess; trauma; pediatrics; injury severity INTRODUCTION Traumatic injuries are the leading cause of pediatric mor- bidity and mortality (1,2). In the United States, more than 50% of pediatric mortality over the age of 1 year is caused by trauma (2). It is vital to assess the status of trauma patients quickly. This assessment is based on clinical evaluation and a small number of laboratory tests. Base excess (BE) is considered a predictor of mortality and severity of injury in trauma, as it indicates inadequate perfusion and tissue hypoxia. Its ready availability, ease and speed of calculation, and the lack of other good indicators also contribute to its role in the initial assessment of trauma patients (3–14). BE had been widely examined in different settings (3–10). However, few studies have examined the role of BE in pediatric trauma patients (11–14). Those studies typically included the most severe trauma cases. The results of the studies suggest that low BE is a good predictor for injury severity and mortality. Injury Severity Score (ISS) is a widely used scoring method for trauma patients that shows a good correlation RECEIVED: 10 October 2012; FINAL SUBMISSION RECEIVED: 8 April 2013; ACCEPTED: 30 April 2013 496 The Journal of Emergency Medicine, Vol. 45, No. 4, pp. 496–501, 2013 Copyright Ó 2013 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/$ - see front matter http://dx.doi.org/10.1016/j.jemermed.2013.04.035