Hypotension and the need for transfusion in pediatric blunt spleen and liver injury: An ATOMAC+ prospective study

Infographic · Oct 2018 · 1 min read

In brief

Multi-center prospective study of 47 pediatric patients with blunt liver or spleen injury requiring early transfusion found that less than half presented with hypotension, challenging its use as a reliable predictor of transfusion need. Findings suggest clinicians should maintain high suspicion for significant hemorrhage even in normotensive children with solid organ injury.

Less than half (47%) of pediatric BLSI patients requiring early transfusion presented with hypotension, limiting its predictive value.
Median time to first transfusion was similar regardless of hypotension status (2 vs 2.5 hours), suggesting comparable urgency.
Hypotensive patients were significantly older (median 15 vs 9.5 years) and had higher mortality (14% vs 0%).
Clinicians should maintain high suspicion for transfusion need in pediatric BLSI even without documented hypotension.
Transfusion volumes in first 24h were similar between groups (18.2 vs 13.9 mL/kg), indicating comparable resuscitation needs.

Written by the GCMD Library team from the infographic.

The infographic uses a split-panel design with two rounded rectangles: blue on the left representing the hypotension group and green on the right for the no-hypotension group. Each panel contains an IV bag icon and displays transfusion volumes. Arrow bullets below highlight key findings, with the main conclusion emphasized in a blue banner at the bottom.

Purpose

Children with blunt liver or spleen injury (BLSI) requiring early transfusion may present without hypotension despite significant hypovolemia. This study sought to determine the relationship between early transfusion in pediatric BLSI and hypotension.

Methods

Secondary analysis of a 10-institution prospective observational study was performed of patients 18 years and younger presenting with BLSI. Patients with central nervous system (CNS) injury were excluded. Children receiving blood transfusion within 4 h of injury were evaluated. Time to first transfusion, vital signs, and physical exams were analyzed. Patients with hypotension were compared to those without hypotension.

Results

Of 1008 patients with BLSI, 47 patients met inclusion criteria. 22 (47%) had documented hypotension. There was no statistical difference in median time to first transfusion for those with or without hypotension (2 h vs. 2.5 h, p = 0.107). The hypotensive group was older (median 15.0 versus 9.5 years; p = 0.007). Median transfusion volume in the first 24 h was 18.2 mL/kg (IQR: 9.6, 25.7) for those with hypotension and 13.9 mL/kg (IQR: 8.3, 21.0) for those without (p = 0.220). Mortality was 14% (3/22) in children with hypotension and 0% (0/25) in children without hypotension.

Conclusion

Hypotension occurred in less than half of patients requiring early transfusion following pediatric BLSI suggesting that hypotension does not consistently predict the need for early transfusion.

The text in the image

Does hypotension demand transfusion in pediatric blunt spleen and liver injury? | Summer R. Magoteaux, et al. | Journal of Pediatric Surgery | 47 blunt liver or spleen injury (BLSI) | Hypotension (n=22) | No Hypotension (n=25) | Total PRBC transfusion volume | 21.3 mL/kg transfused | 18.1 mL/kg transfused | NO DIFFERENCE in the transfusion volume for those with or without hypotension | Mortality was 14% in pts with hypotension & 0% in pts without hypotension | Hypotension following pediatric BLSI does not consistently predict the need for early transfusion | The visual abstract created by Abdulraouf Lamoshi

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