Pediatric Trauma Society

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Pediatric Massive Transfusion at a Level I Trauma Center: What's the Trigger?
Caroline S. Zhu1; Ashley C. McGinity, MD2; Tracy Cotner-Pouncy, RN3; Brian J. Eastridge, MD2; Sondra Epley, RN4; Leslie J. Greebon, MD2; Rachelle B. Jonas, RN2; Lillian F. Liao, MD2; Susannah E. Nicholson, MD2; Ronald M. Stewart, MD2; Donald H. Jenkins, MD5
1UT San Antonio / UT Health San Antonio, San Antonio, TX; 2University of Texas Health San Antonio, San Antonio, TX; 3University Health System at San Antonio, San Antonio, TX; 4University Health System, San Antonio, TX; 5University of Texas Health San Antonio, San Anotnio, TX

Contemporary medical literature suggests that massive transfusion protocols (MTP) reduce mortality in severely injured children with hemorrhage. The goal of this study was to compare pediatric patients who received massive transfusion to those who received non-massive transfusion within the first 24 hours of admission to identify potential triggers for MTP activation.

All pediatric trauma patients from January 2015 to August 2017 requiring transfusion in the first 24 hours of stay were identified. Basic demographics, physiologic measures, and transfused blood volumes were collected.

Over 2000 pediatric trauma patients were studied; 70 patients were in the cohort, 50% (35/70) of whom received massive transfusion, defined as 40 mL/kg of blood products. Pre-hospital vitals are shown in Table 1. Diastolic blood pressure ≤60, mean arterial pressure <70, and shock index (SI) >1.4 were weakly predictive of MTP with positive predictive values (PPV) of 0.61, 0.58, and 0.63, respectively. Penetrating injury was highly predictive of MTP (PPV=0.71). The combination of penetrating injury and SI >1.4 was perfectly predictive of MTP (PPV=1.0).

Our data demonstrate a high rate of MTP in injured children who received blood transfusion. We recommend the use of shock index as a transfusion trigger. For ease of use, these potential triggers are readily available in all patients and may represent a critical decision support tool to initiate pre-hospital transfusion or massive transfusion.

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