Coagulopathy and Transfusion Ratios in Pediatric Trauma.
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Topic overview
BACKGROUND: Coagulopathy has been associated with poor outcomes in adult and pediatric trauma. Previous clinical trials have shown benefits with balanced transfusion ratios in trauma resuscitation in adults, but smaller retrospective studies have not established the same in pediatrics. We constructed a pediatric trauma database at a level one trauma center for analysis.
METHODS: The institutional trauma registry was queried for all pediatric trauma activations from 2008 to 2018. Patient identifiers were used to identify laboratory data from the electronic data warehouse.
RESULTS: 2769 pediatric trauma patients were identified with 1492 arriving direct from the scene. Of those with complete transport data available, 81% arrived within 60 minutes from time of injury. 52 patients were transfused in the first 24 hours, with 25 receiving greater than an estimated 40 ml/kg of blood products. No significant difference in ratios of red cell to plasma transfused at 24 hours was observed between patients surviving to discharge (1.4, 95% CI 1.0 to 1.6) and deceased (1.7, 95% CI 1.4 to 1.9) (P = 0.087).Among direct admissions, an abnormal prothrombin time (PT) or partial thromboplastin time (PTT) taken within 2 hours of arrival was significantly associated with in-hospital mortality (P = 0.003 and
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