Hypotension and the need for transfusion in pediatric blunt spleen and liver injury: An ATOMAC+ prospective study
Topic overview
Prospective 10-institution study of 47 pediatric patients with blunt liver or spleen injury requiring early transfusion found that less than half presented with hypotension, despite needing blood products within 4 hours. Findings challenge reliance on hypotension as a primary indicator for transfusion in pediatric solid organ injury.
Key takeaways
- Nearly half (53%) of pediatric BLSI patients requiring early transfusion never developed hypotension despite significant blood loss.
- Hypotension is an unreliable predictor of transfusion need in pediatric blunt liver/spleen injury—don't wait for it to transfuse.
- Older children (median 15 vs 9.5 years) were more likely to present with hypotension when requiring early transfusion.
- Median time to first transfusion was similar (2-2.5 hours) regardless of hypotension status in children with BLSI.
- Mortality was 14% in hypotensive vs 0% in normotensive transfused patients, suggesting hypotension marks more severe injury.
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