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Massive transfusion in paediatric and adolescent trauma patients: incidence, patient profile, and outcomes prior to a
Michael Hobbs Livingston1, Supriya Singh2, Neil Howard Merritt3
1Division of General Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
Insights
Massive transfusion occurred in 3% of pediatric trauma patients, associated with coagulopathy and poor outcomes. Protocols are needed for coordinated resuscitation with appropriate blood products.
Area of Science:
- Trauma Surgery
- Paediatric Critical Care
- Haematology
Background:
- Massive transfusion protocols (MTPs) are critical in managing severe trauma.
- The incidence and outcomes of massive transfusion in paediatric trauma without an MTP are not well-defined.
Purpose of the Study:
- To quantify the incidence, patient profile, and outcomes of massive transfusion in paediatric trauma patients.
- To establish baseline data prior to implementing a massive transfusion protocol.
Main Methods:
- Retrospective review of paediatric trauma patients (age < 18, ISS > 12) at London Health Sciences Centre (2006-2011).
- Defined massive transfusion as >40mL/kg packed red blood cells within 24 hours.
Main Results:
- 3% (13/435) of patients received massive transfusion.
- Massively transfused patients had higher coagulopathy rates (85% vs 49%), severe head injuries (92%), longer hospital stays (36 days), and increased mortality (38%).
- Only 8/13 massively transfused patients received timely fresh frozen plasma and platelets without an MTP.
Conclusions:
- Massive transfusion in paediatric trauma is infrequent but associated with significant coagulopathy and adverse outcomes.
- The findings underscore the need for established MTPs to ensure timely and appropriate resuscitation.
- Protocols are essential for coordinated care, including adequate fresh frozen plasma, platelet, and cryoprecipitate administration.
Objectives:
The purpose of this study was to quantify the incidence, patient profile, and outcomes associated with massive transfusion in paediatric trauma patients prior to establishing a massive transfusion protocol.
Methods:
We performed a retrospective review of paediatric trauma patients treated at London Heath Sciences Centre between January 1, 2006, and December 31, 2011. Inclusion criteria were Injury Severity Score (ISS) greater than 12 and age less than 18 years.
Results:
435 patients met the inclusion criteria. Three hundred and fifty-six (82%) did not receive packed red blood cells in the first 24h, 66 (15%) received a non-massive transfusion (<40mL/kg), and 13 (3%) received a massive transfusion (>40mL/kg). Coagulopathy of any kind was more common in massive transfusion (11/13; 85%) than non-massive (32/66; 49%) (p=0.037). Hyperkalemia (18% versus 23%; p=0.98) and hypocalcemia (41% versus 46%; p=1.00) were similar in both groups. Of the 13 massively transfused patients, 9 had multisystem injuries due to a motor vehicle collision, 3 had non-accidental head injuries requiring surgical evacuation, and 1 had multiple stab wounds. In the absence of a massive transfusion protocol, only 8 of the 13 patients received both fresh frozen plasma and platelets in the first 24h. Massive transfusion occurred in patients from across the age spectrum and was associated with severe injuries (mean ISS=33), a higher incidence of severe head injuries (92%), longer hospital stay (mean=36 days), and increased mortality (38%).
Conclusions:
This study is the first to describe the incidence, complications, and outcomes associated with massive transfusion in paediatric trauma patients prior to a massive transfusion protocol. Massive transfusion occurred in 3% of patients and was associated with coagulopathy and poor outcomes. Protocols are needed to ensure that resuscitation occurs in a coordinated fashion and that patients are given appropriate amounts of fresh frozen plasma, platelets, and cryoprecipitate.
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