Elissa K Butler1,2,3, Brianna M Mills1, Saman Arbabi1,2, Eileen M Bulger1,2, Monica S Vavilala1,4, Jonathan I Groner5,6, Lynn G Stansbury1,7, John R Hess8, Frederick P Rivara1,9. 1. Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA. 2. Department of Surgery, University of Washington, Seattle, WA. 3. Department of Surgery, SUNY Upstate Medical University, Syracuse, NY. 4. Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA. 5. Center for Pediatric Trauma Research, Nationwide Children's Hospital, Columbus, OH. 6. Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH. 7. Shock Trauma and Anesthesia Research Center, University of Maryland, Baltimore, MD. 8. Department of Laboratory Medicine, University of Washington, Seattle, WA. 9. Department of Pediatrics, University of Washington, Seattle, WA.
Abstract
OBJECTIVES: To determine if higher fresh frozen plasma and platelet to packed RBC ratios are associated with lower 24-hour mortality in bleeding pediatric trauma patients. DESIGN: Retrospective cohort study using the Pediatric Trauma Quality Improvement Program Database from 2014 to 2016. SETTING: Level I and II pediatric trauma centers participating in the Trauma Quality Improvement Program PATIENTS:: Injured children (≤ 14 yr old) who received massive transfusion (≥ 40 mL/kg total blood products in 24 hr). Of 123,836 patients, 590 underwent massive transfusion, of which 583 met inclusion criteria. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Ratios of fresh frozen plasma:packed RBC and platelet:packed RBC. Of the 583 patients, 60% were male and the median age was 5 years (interquartile range, 2-10 yr). Overall mortality was 19.7% (95% CI, 16.6-23.2%) at 24 hours. There was 51% (adjusted relative risk, 0.49; 95% CI, 0.27-0.87; p = 0.02) and 40% (adjusted relative risk, 0.60; 95% CI, 0.39-0.92; p = 0.02) lower risk of death at 24 hours for the high (≥ 1:1) and medium (≥ 1:2 and < 1:1) fresh frozen plasma:packed RBC ratio groups, respectively, compared with the low ratio group (< 1:2). Platelet:packed RBC ratio was not associated with mortality (adjusted relative risk, 0.94; 95% CI, 0.51-1.71; p = 0.83). CONCLUSIONS: Higher fresh frozen plasma ratios were associated with lower 24-hour mortality in massively transfused pediatric trauma patients. The platelet ratio was not associated with mortality. Although these findings represent the largest study evaluating blood product ratios in pediatric trauma patients, prospective studies are necessary to determine the optimum blood product ratios to minimize mortality in this population.
OBJECTIVES: To determine if higher fresh frozen plasma and platelet to packed RBC ratios are associated with lower 24-hour mortality in bleeding pediatric traumapatients. DESIGN: Retrospective cohort study using the Pediatric Trauma Quality Improvement Program Database from 2014 to 2016. SETTING: Level I and II pediatric trauma centers participating in the Trauma Quality Improvement Program PATIENTS:: Injured children (≤ 14 yr old) who received massive transfusion (≥ 40 mL/kg total blood products in 24 hr). Of 123,836 patients, 590 underwent massive transfusion, of which 583 met inclusion criteria. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Ratios of fresh frozen plasma:packed RBC and platelet:packed RBC. Of the 583 patients, 60% were male and the median age was 5 years (interquartile range, 2-10 yr). Overall mortality was 19.7% (95% CI, 16.6-23.2%) at 24 hours. There was 51% (adjusted relative risk, 0.49; 95% CI, 0.27-0.87; p = 0.02) and 40% (adjusted relative risk, 0.60; 95% CI, 0.39-0.92; p = 0.02) lower risk of death at 24 hours for the high (≥ 1:1) and medium (≥ 1:2 and < 1:1) fresh frozen plasma:packed RBC ratio groups, respectively, compared with the low ratio group (< 1:2). Platelet:packed RBC ratio was not associated with mortality (adjusted relative risk, 0.94; 95% CI, 0.51-1.71; p = 0.83). CONCLUSIONS: Higher fresh frozen plasma ratios were associated with lower 24-hour mortality in massively transfused pediatric traumapatients. The platelet ratio was not associated with mortality. Although these findings represent the largest study evaluating blood product ratios in pediatric traumapatients, prospective studies are necessary to determine the optimum blood product ratios to minimize mortality in this population.
Authors: John B Holcomb; Don Jenkins; Peter Rhee; Jay Johannigman; Peter Mahoney; Sumeru Mehta; E Darrin Cox; Michael J Gehrke; Greg J Beilman; Martin Schreiber; Stephen F Flaherty; Kurt W Grathwohl; Phillip C Spinella; Jeremy G Perkins; Alec C Beekley; Neil R McMullin; Myung S Park; Ernest A Gonzalez; Charles E Wade; Michael A Dubick; C William Schwab; Fred A Moore; Howard R Champion; David B Hoyt; John R Hess Journal: J Trauma Date: 2007-02
Authors: Jeanne E Hendrickson; Beth H Shaz; Greg Pereira; Paul M Parker; Paula Jessup; Falisha Atwell; Beth Polstra; Elizabeth Atkins; Karen K Johnson; Gaobin Bao; Kirk A Easley; Cassandra D Josephson Journal: Transfusion Date: 2011-12-01 Impact factor: 3.157
Authors: Matthew A Borgman; Philip C Spinella; Jeremy G Perkins; Kurt W Grathwohl; Thomas Repine; Alec C Beekley; James Sebesta; Donald Jenkins; Charles E Wade; John B Holcomb Journal: J Trauma Date: 2007-10
Authors: Christopher W Snyder; Jordan A Weinberg; Gerald McGwin; Sherry M Melton; Richard L George; Donald A Reiff; James M Cross; Jennifer Hubbard-Brown; Loring W Rue; Jeffrey D Kerby Journal: J Trauma Date: 2009-02
Authors: John B Holcomb; Deborah J del Junco; Erin E Fox; Charles E Wade; Mitchell J Cohen; Martin A Schreiber; Louis H Alarcon; Yu Bai; Karen J Brasel; Eileen M Bulger; Bryan A Cotton; Nena Matijevic; Peter Muskat; John G Myers; Herb A Phelan; Christopher E White; Jiajie Zhang; Mohammad H Rahbar Journal: JAMA Surg Date: 2013-02 Impact factor: 14.766
Authors: Adil H Haider; Zain G Hashmi; Syed Nabeel Zafar; Renan Castillo; Elliott R Haut; Eric B Schneider; Edward E Cornwell; Ellen J Mackenzie; David T Efron Journal: J Trauma Acute Care Surg Date: 2014-04 Impact factor: 3.313
Authors: Nickolay P Markov; Joseph J DuBose; Daniel Scott; Brandon W Propper; W Darrin Clouse; Billy Thompson; Lorne H Blackbourne; Todd E Rasmussen Journal: J Vasc Surg Date: 2012-07-13 Impact factor: 4.268
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: Marianne E Nellis; Kenneth E Remy; Jacques Lacroix; Jill M Cholette; Melania M Bembea; Robert T Russell; Marie E Steiner; Susan M Goobie; Adam M Vogel; Gemma Crighton; Stacey L Valentine; Meghan Delaney; Robert I Parker Journal: Pediatr Crit Care Med Date: 2022-01-01 Impact factor: 3.971
Authors: Julie C Leonard; Cassandra D Josephson; James F Luther; Stephen R Wisniewski; Christine Allen; Fabrizio Chiusolo; Adrienne L Davis; Robert A Finkelstein; Julie C Fitzgerald; Barbara A Gaines; Susan M Goobie; Sheila J Hanson; Hilary A Hewes; Laurie H Johnson; Mark O McCollum; Jennifer A Muszynski; Alison B Nair; Robert B Rosenberg; Thomas M Rouse; Athina Sikavitsas; Marcy N Singleton; Marie E Steiner; Jeffrey S Upperman; Adam M Vogel; Hale Wills; Margaret K Winkler; Philip C Spinella Journal: Crit Care Med Date: 2021-11-01 Impact factor: 9.296