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Massive Transfusion in Pediatric Trauma: Analysis of the National Trauma Databank
Michelle Shroyer, MPH1, Russell Griffin, PhD2, Vincent Mortellaro, MD1 and Robert T. Russell, MD, MPH1; 1Children's of Alabama, University of Alabama at Birmingham, Birmingham AL; 2School of Public Health, University of Alabama at Birmingham, Birmingham AL

Abstract: Introduction: Massive transfusion is less commonly required during pediatric trauma resuscitation than in adults. We aim to characterize pediatric trauma patients undergoing MT, predictive parameters present upon arrival, and the mortality associated with MT. Methods: Data from the National Trauma Databank (2010-2012), which is a registry of US trauma data maintained by the ACS, was analyzed. We included pediatric trauma patients ≤ 14 years that underwent MT, as defined by 40 ml/kg of any blood products within the first 24 hours following admission. We compared the MT group with children receiving any transfusion within the first 24 hours following admission. Univariate and multivariate analysis were performed. Results: Of 356,583 pediatric trauma patients, 13,523 (4%) received any transfusion in the first 24 hours and 173 (0.04%) had a MT. Univariate analysis demonstrated significant differences between these groups in respect to age, gender, race, presenting temperature, pulse, systolic blood pressure, Glasgow Coma Scale Score (GCS), and Injury Severity Score (ISS). On multivariate analysis, factors predicting MT were: older patients (5 to 12: OR 2.71, p=0.006, and ≥ 12: OR 5.14, p< 35: OR 2.48, p< 0.025), low GCS (GCS<8: OR 2.82, p=0.009), and ISS≥25 (OR 2.01, p=0.03). Overall mortality for the entire group, any transfusion group, and MT group were 2.5%, 13.6%, and 50.6% respectively (p<0.001). Conclusions: MT in pediatric trauma is an uncommon event associated with a significant mortality. Patients undergoing MT are older, have physiologic differences, and different injury severity than transfused trauma patients.

Objective: Identify children involved in trauma at risk for massive transfusion.

Objective Content: At the end of this activity, the learner will be able to identify children at risk for massive transfusion are older children, hypothermic, and have higher ISS and lower GCS.

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