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Shock Index And Systolic Blood Pressure As Triggers For Pediatric Massive Transfusion
Caroline S. Zhu1, Ashley C. McGinity1, Tracy Cotner-Pouncy2, Brian J. Eastridge1, Sondra Epley2, Rachelle B. Jonas1, Randall Schaefer3, *Lillian F. Liao1, Susannah E. Nicholson1, Ronald M. Stewart1, Christopher J. Winckler1, Donald H. Jenkins1
1UT Health San Antonio, San Antonio, TX;2University Hospital, San Antonio, TX;3Southwest Texas Regional Advisory Council, San Antonio, TX

Background: This study compared injured children requiring massive transfusion (MTP) to other injured children to identify triggers for MTP activation.
Methods: All injured children (January 2015-January 2018) were identified. MTP was defined as 40 mL/kg of blood products in the first 24 hours of admission. Patient demographics, vital signs, shock index [HR/SBP (SI)], and injury severity scores were compared. Significance was determined using independent samples t-test and chi-square test.
Findings: 39 of the 5,459 pediatric patients (0.7%) had a MTP; all-cause mortality was 49% (19/39) compared to 0.4% (24/5420). The average age in both populations was 8 years. MTP patients, compared to 85 non-MTP patients who received blood, received 2330 mL vs 904 mL packed red blood cells, 1498 mL vs 571 mL of fresh frozen plasma, and 462 mL vs 269 mL of platelets.
Both SBP<100 and SI>1.4 were highly specific (88% and 92%, respectively) of MTP. Combining SBP<100 and SI>1.4 was more specific (95%). Positive likelihood ratios for patients with SBP <100, with SI>1.4, and with both SBP<100 and SI>1.4 were 5.2, 5.8, and 8.3 times more likely to require MTP, respectively.
Conclusions: MTP in injured children is rare; mortality is high. SI is highly specific for MTP and has increased specificity when combined with SBP. We recommend SI and SBP as triggers for initiation of pre-hospital whole blood transfusion in injured children.

Table 1. ISS, SBP, and SI were significantly different between the MTP versus non-MTP patients.
TotalMTPNon-MTPp-value
# of Male Patients3341 (61.2%)24 (61.5%)3317 (61.2%)0.9655
Injury Severity Score4.923.34.70.009
Systolic Blood Pressure118981200.007
Shock Index0.951.510.940.002


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