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Ratios Of Resuscitation For Pediatric Trauma Massive Transfusions: Kids Really Aren't Just Small Adults
Manmeet Sehdev1, Areg Grigorian2, Catherine Kuza2, Matthew Dolich2, Boris Borazjani2, Michael Lekawa2, *Jeffry Nahmias2
1UC Irvine School of Medicine, Irvine, CA;2UC Irvine Medical Center, Orange, CA

Background: The utilization rate and impact of various ratios of transfusions for pediatric trauma patients (PTPs) are unknown. Therefore, we sought to determine the risk for mortality in PTPs receiving a massive transfusion protocol (MTP) of ≥6 units of packed red blood cells (PRBC) within 24 hours. We compared PRBC: Plasma ratio of >2:1 (Unbalanced Ratios, UR) versus ≤2:1 (Balanced Ratios, BR), hypothesizing a decreased mortality risk with BR.
Methods: The Trauma Quality Improvement Program was queried (2014-2016) for PTPs receiving a MTP. A multivariable logistic regression model was used to determine risk of mortality.
Results: From 239 PTPs receiving a MTP, 98 (41%) received an UR, whereas 141(59%) received a BR. The median ratios, respectively, were 2.7:1 and 1.2:1. Compared to BR patients, UR patients had no differences in injury severity score (ISS), hypotension on admission, and intensive care unit stay (all p>0.05). The mortality rate for BR and UR were similar (46.1% vs. 52.0%, p=0.36). Controlling for age, ISS, and severe head injury, UR demonstrated no difference in mortality risk compared to BR (p= 0.27).
Conclusion: In contrast to adult studies, this study showed that MTP ratios of >2:1 were not associated with worse mortality compared to BR for PTPs. These results suggest pediatric MTP resuscitation may not require strict BR as has been shown beneficial in adult trauma patients. Future prospective studies are needed to evaluate the optimal ratio for pediatric MTP resuscitation.


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