Defining massive transfusion in civilian pediatric trauma
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In brief
In brief
Study of 270 severely injured children identifies 37 ml/kg over 4 hours as optimal threshold for defining massive transfusion in pediatric trauma. This volume threshold predicts need for hemorrhage control procedures and correlates with early mortality, providing evidence-based guidance for pediatric trauma resuscitation protocols.
Written by the GCMD Library team from the article.
Purpose
The purpose of this study was to identify an optimal definition of massive transfusion (MT) in civilian pediatric trauma.
Methods
Severely 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].
Results
Of 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