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Whole Blood Hemostatic Resuscitation in Pediatric Trauma: A Nationwide Propensity Matched Analysis
Mohamad Chehab, *Marion Henry, Muhammad Khurrum, Letitia Bible, Samer Asmar, Michael Ditillo, Molly Douglas, Lourdes Castanon, Bellal Joseph
The University of Arizona, Tucson, AZ

Background: The use of whole blood (WB) in resuscitating pediatric trauma patients has emerged following its promising role in adults. Although transfusing WB in children was shown to be feasible and safe, its effectiveness remains unexplored. This study aims to assess the impact of WB resuscitation on hemostasis in pediatric trauma patients.
Methods: Children (1-16 years) requiring transfusion within 4 hours of presentation were identified in the Trauma Quality Improvement Program 2017 database. Patients were stratified into those receiving WB as an adjunct to component transfusions (CT) vs. CT alone. Propensity-matching (1:2 ratio) was performed based on patients’ demographics, injuries, and hospital characteristics.
Findings: A total of 115 children receiving WB were matched to 230 patients receiving CT only. Mean age was 11±5 years, 68% were male, median ISS was 37[27-48], and 54% required surgical intervention for hemorrhage control. Transfusion requirements were significantly decreased in children receiving WB, both at 4 and 24 hours. (Table 1) Rates of 24-hour (20.9 vs. 22.9%; p=0.661) and in-hospital mortality (33.9 vs. 37.7%; p=0.480) were comparable. Similarly, there was no difference in hospital LOS (9[3-16] vs. 10[4-20] days; p=0.200) and rate of major complications (14.3 vs. 15.5%; p=0.782).
Conclusions: Utilizing WB as an adjunct to CT was associated with improved hemostasis in pediatric trauma patients. Future studies remain necessary to further validate the use of WB in resuscitation protocols.

Table 1: Transfusion requirements
OutcomesWB+CT(n=115)CT(n=230)P value
4-hour Transfusion, units, median [IQR]
PRBCs4 [2-9]6 [4-10]0.014*
Plasma2 [0-4.75]4 [2-7]<0.001*
Platelets0 [0-2]1 [1-2]<0.001*
WB1 [1,1]--
24-hour Transfusion, units, median [IQR]
PRBCs5 [3-11]7 [4-12]0.009*
Plasma3 [0.25-7]5 [3-8]0.002*
Platelets1 [0-2]2 [1,3]0.001*
WB1 [1,1]--

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