Daniel K Noland1, Nadja Apelt1, Cynthia Greenwell2, Jefferson Tweed1, David M Notrica3, Nilda M Garcia4, R Todd Maxson5, James W Eubanks6, Adam C Alder1. 1. Children's Medical Center, the flagship of Children's Health(SM), 1935 Medical District Dr, Dallas, TX, USA 75235. 2. Children's Medical Center, the flagship of Children's Health(SM), 1935 Medical District Dr, Dallas, TX, USA 75235. Electronic address: Cynthia.greenwell@childrens.com. 3. Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ, USA 85016. 4. Dell Children's Medical Center, 4900 Mueller Blvd, Austin, TX, USA 78723. 5. Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR, USA 72202. 6. Le Bonheur Children's Hospital, 50 N Dunlap St, Memphis, TN, USA 38103.
Abstract
BACKGROUND/ PURPOSE: Massive transfusion protocols (MTPs) are considered valuable in pediatric trauma. Important questions regarding the survival benefit and optimal blood component ratio remain unknown. METHODS: The study time frame was January 2007 through December 2013 five Level I Pediatric Trauma Centers reviewed all trauma activations involving children ≤18 years of age. Included were patients who either had the institutional MTP or received >20 mL/kg or > 2 units packed red blood cells (PRBCs). RESULTS: 110/202 qualified for inclusion. Median age was 5.9 years (3.0-11.4). 73% survived to discharge; median hospitalization was 10 (3.1-22.8) days. Survival did not vary by arrival hemoglobin (Hgb), gender or age. Partial prothrombin time (PTT), INR, GCS and injury severity score (ISS) significantly differed for nonsurvivors (all p < 0.05). Logistic regression found increased mortality (OR 3.08 (1.10-8.57), 95% CI; p = 0.031) per unit increase over a 1:1 ratio of pRBC:FFP. CONCLUSION: In pediatric trauma pRBC:FFP ratio of 1:1 was associated with the highest survival of severely injured children receiving massive transfusion. Ratios 2:1 or ≥3:1 were associated with significantly increased risk of death. These data support a higher proportion of plasma products for pediatric trauma patients requiring massive transfusion. LEVEL OF EVIDENCE: Level IV.
BACKGROUND/ PURPOSE: Massive transfusion protocols (MTPs) are considered valuable in pediatric trauma. Important questions regarding the survival benefit and optimal blood component ratio remain unknown. METHODS: The study time frame was January 2007 through December 2013 five Level I Pediatric Trauma Centers reviewed all trauma activations involving children ≤18 years of age. Included were patients who either had the institutional MTP or received >20 mL/kg or > 2 units packed red blood cells (PRBCs). RESULTS: 110/202 qualified for inclusion. Median age was 5.9 years (3.0-11.4). 73% survived to discharge; median hospitalization was 10 (3.1-22.8) days. Survival did not vary by arrival hemoglobin (Hgb), gender or age. Partial prothrombin time (PTT), INR, GCS and injury severity score (ISS) significantly differed for nonsurvivors (all p < 0.05). Logistic regression found increased mortality (OR 3.08 (1.10-8.57), 95% CI; p = 0.031) per unit increase over a 1:1 ratio of pRBC:FFP. CONCLUSION: In pediatric trauma pRBC:FFP ratio of 1:1 was associated with the highest survival of severely injured children receiving massive transfusion. Ratios 2:1 or ≥3:1 were associated with significantly increased risk of death. These data support a higher proportion of plasma products for pediatric traumapatients requiring massive transfusion. LEVEL OF EVIDENCE: Level IV.
Authors: Robert Russell; David F Bauer; Susan M Goobie; Thorsten Haas; Marianne E Nellis; Daniel K Nishijima; Adam M Vogel; Jacques Lacroix Journal: Pediatr Crit Care Med Date: 2022-01-01 Impact factor: 3.624
Authors: Ryan Phillips; Hunter Moore; Denis Bensard; Niti Shahi; Gabrielle Shirek; Marina L Reppucci; Maxene Meier; John Recicar; Shannon Acker; John Kim; Steven Moulton Journal: Pediatr Surg Int Date: 2021-09-17 Impact factor: 1.827