Defining massive transfusion in civilian pediatric trauma |
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Authors: | Eric Rosenfeld Patricio Lau Wei Zhang Robert T. Russell Sohail R. Shah Bindi Naik-Mathuria Adam M. Vogel |
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Affiliation: | 1. Department of Pediatric Surgery, Texas Children''s Hospital and Baylor College of Medicine, Houston, TX;2. Outcomes & Impact Service, Texas Children''s Hospital, Houston, TX;3. Department of Pediatric Surgery, Children''s Hospital of Alabama, Birmingham, AL |
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Abstract: | PurposeThe purpose of this study was to identify an optimal definition of massive transfusion (MT) in civilian pediatric trauma.MethodsSeverely injured children (age ≤ 18 years, injury severity score ≥ 25) in the Trauma Quality Improvement Program research datasets 2014–2015 that received blood products were identified. Children with traumatic brain injury and non-survivable injuries were excluded. Early mortality was defined as death within 24 h and delayed mortality as death after 24 h from hospital admission. Receiver operating curves and sensitivity and specificity analysis identified an MT threshold. Continuous variables are presented as median [IQR].ResultsOf the 270 included children, the overall mortality was 27% (N = 74). There were no differences in demographics or mechanism of injury between children that lived or died. Sensitivity and specificity for early mortality was optimized at a 4-h transfusion volume of 37 ml/kg. After controlling for other significant variables, a threshold of 37 ml/kg/4 h predicted the need for a hemorrhage control procedure (OR 8.60; 95% CI 4.25–17.42; p < 0.01) and early mortality (OR 4.24; 95% CI 1.96–9.16; p < 0.01).ConclusionAn MTP threshold of 37 mL/kg/4 h of transfused blood products predicted the need for hemorrhage control procedures and early mortality. This threshold may provide clinicians with a timely prognostic indicator, improve research methodology, and resource utilization.Type of StudyDiagnostic Test.Level of EvidenceIII. |
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Keywords: | Massive transfusion Pediatric trauma Hemorrhagic shock |
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