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Pediatric Trauma Patients at Risk for Coagulopathy: Blood Product vs. Crystalloid Resuscitation

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Pediatric Trauma Patients at Risk for Coagulopathy: Blood Product vs. Crystalloid Resuscitation
Bola Aladegbami, MD, Pam Choi, MD, Yan Yan, MD, PhD, Philip C. Spinella, MD, Martin S. Keller, MD and Adam M. Vogel, MD Washington University School of Medicine, St. Louis MO

Purpose: To determine if outcomes differ among pediatric trauma patients at risk for coagulopathy who a receive blood product versus crystalloid based resuscitation. Methods: Injured children, aged <18 years, admitted to the intensive care unit (ICU) between 2008-2012 and at risk for coagulopathy (initial Glasgow Coma Score ≤ 14 or penetrating truncal trauma) were reviewed. Patients who died within one hour of presentation or had non-survivable injuries were excluded. Multiple regression analysis, controlling for demographic and injury variables, was performed to evaluate the impact of blood product and crystalloid utilization during the first 24 hours on outcomes. Results: 197 patients were included; 73 received blood products and 124 received only crystalloid. 21 patients received ≥ 40ml/kg of blood products. The mean age was 8.7±6 years, the mean ISS was 19.8±11.6, and 88.3% sustained blunt trauma. Mortality was 4.6%. Patients receiving blood products had a higher ISS (29.1±9.2 vs. 14.3±9.3), head AIS (4.3±1 vs 3±1.2), and total fluid volume (156±87.2 vs 59.6±42.4 ml/kg/24 hours). Regression analysis showed no difference in mortality, infections or acute kidney injury between groups. Patients receiving blood products had lower ICU (3.2±1.5 days, p=0.03) and ventilator-free-days (3±1.4 days, p=0.04). Patients that received ≥ 40ml/kg vs ˂ 40ml/kg of blood products had similar outcomes. Conclusions: Pediatric trauma patients at risk for coagulopathy who receive a blood product resuscitation spend more time in the ICU and on the ventilator but have no increased complications or mortality. Adequately powered, multi-institutional, prospective studies are needed to elucidate resuscitation strategies in pediatric trauma.

Objective: At the end of this activity the learner will be able to discuss the risks associated with resuscitation in the pediatric trauma population and identify the need for balanced resuscitation in the pediatric trauma population.

Objective Content: Identify the lack of adequate research on balanced resuscitation in the pediatric trauma population Restate the need for evidence based transfusion protocols in the pediatric trauma population Create avenues to establish the framework for a multi-institutional prospective study.


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