The evolution of pediatric transfusion practice during combat operations 2001-2013

Area of Science:

• Trauma Resuscitation
• Pediatric Critical Care
• Military Medicine

Background:

• Hemostatic resuscitation principles have transformed adult trauma care.
• Pediatric resuscitation practices have evolved but remain unquantified.
• This study evaluates changes in pediatric resuscitation within a combat trauma system.

Purpose of the Study:

• To quantify changes in pediatric resuscitation practices over time.
• To assess the impact of these changes on patient outcomes.
• To compare early and late resuscitation cohorts in a combat setting.

Main Methods:

• Analysis of the Department of Defense Trauma Registry (2001-2013) for pediatric patients.
• Exclusion of burn, drowning, and missing injury severity score cases.
• Calculation of fluid and blood product volumes, tranexamic acid use, and comparison of outcomes between early and late cohorts.

Main Results:

• Increased severity of injuries, including explosion-related trauma and head injuries, was observed over time.
• Significant increases in transfused (TX+) and massively transfused (MT+) patients were noted.
• Despite increased injury severity, overall mortality remained stable, and mortality decreased in MT+ patients.

Conclusions:

• Pediatric combat casualty care has adopted a more hemostatic transfusion approach.
• Mortality remained low and stable, decreasing in massively transfused patients despite more severe injuries.
• Further research is needed to optimize resuscitation for critically injured children.