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Pediatric Damage Control Resuscitation: Are They Really Small Adults?
Omar Obaid, Adam Nelson, *Marion Henry, Molly Douglas, Lourdes Castanon, Letitia Bible, Michael Ditillo, Lynn Gries, Andrew Tang, Bellal Joseph
University of Arizona, Tucson, AZ

Background:Balanced component therapy is associated with improvements in outcomes in adult trauma. There is a paucity of data to guide transfusion ratios in children. The aim of our study is to compare outcomes of different transfusion strategies in pediatric trauma.
Methods:
We conducted a (2014-2016) analysis of the ACS-TQIP. We selected all pediatric(age<18)trauma patients who received at least one unit of PRBC and FFP <4 hours of admission. Patients were stratified by PRBC:FFP transfusion ratio into: 1:1, 1:2, 1:3, and 1:3+. Primary outcomes were 24hr-mortality, in-hospital mortality. Secondary outcomes were complications and 24-hour PRBC transfusion requirements. Multivariable logistic regression was performed.
Findings:
1,233 patients were identified(637 1:1, 365 1:2, 116 1:3, 115 1:3+). Mean age was 116y, 70% were male, ISS was 27[20-38], and 62%sustained penetrating injuries. Patients in the 1:1 group had the lowest 24-hour mortality(14%vs.18%vs.22%vs.24%;p=0.01) and in-hospital mortality(32%vs.36%vs.40%vs.44%;p=0.01). No difference was found between the groups in terms of complications(22%vs.21%vs.23%vs.22%;p=0.96) such as ARDS(3.3%vs.3.6%vs.0.9%vs.0%;p=0.10), and AKI(3%vs.2.2%vs.0.9%vs.0.9%;p=0.46). Additionally, the 1:1 group had the lowest PRBC transfusion requirements(3[2-7]vs.5[2-10]vs.6[3-8]vs.6[4-10];p<0.01). On regression analysis a progressive increase in the mortality-adjusted odds-ratio was observed as the PRBC:FFP transfusion ratio increased.
Conclusions:Lower PRBC:FFP ratios were associated with increased survival in children. The resuscitation of pediatric patients should target a 1:1 ratio of PRBC: FFP. Further studies are needed for the development of massive transfusion protocols for this age group.


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