Prehospital Blood Administration In Pediatric Trauma Patients
Christopher A Behr1, Stephen J Strotmeyer1, Francis X Guyette2, *Barbara A Gaines1
1UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA;2Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
Introduction: Early resuscitation with blood products has been associated with improved outcome in adult trauma patients. Little is known regarding the prehospital administration of blood in injured children.
Methods: We performed a retrospective review of hospital and transport records for pediatric trauma patients who received blood products prior to arrival at our Level 1 Trauma Center for the years 2002 - 2019. Patient demographics, blood and crystalloid administered, injuries, mechanisms, procedures, labs, vital signs, transport times/distances, and outcomes were analyzed.
Results: We identified 64 patients, versus 701 who received blood after admission over the same time frame. The majority (89.1%) were transferred from other hospitals and suffered blunt injury (84%). Motor vehicle collision was the most common mechanism (21.9%), followed by gunshot wounds (10.9%); intraabdominal, orthopedic and traumatic brain injuries were the most frequent diagnoses. Median amount of blood given prior to arrival was 10.0 cc/kg, and 40.1% of patients received less. After arrival, patients received an additional 30 cc/kg of blood products within 24 hours. Significant improvement in post-hospital compared to pre-arrival blood pressure was seen in patients administered 10 cc/kg or greater of blood products (p=0.04), and improvement in hemoglobin was seen after 20 cc/kg or greater (p=0.05).
Conclusion: Prehospital administration of blood to injured children is rare, and likely under-utilized. Additionally, many receive inadequate volume for effective resuscitation. Further study is required to define the population who would most benefit from prehospital transfusion.
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