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Updated: Jan 30, 2026
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Defining Massive Transfusion in Civilian Pediatric Trauma With Traumatic Brain Injury
Eric H Rosenfeld1, Patricio Lau1, Megan E Cunningham1
1Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas.
Insights
A threshold of 40 mL/kg/4-h for blood products in pediatric trauma with severe traumatic brain injury (TBI) can identify at-risk patients. This definition aids resource allocation and future research in pediatric TBI management.
Area of Science:
- Trauma Surgery
- Pediatric Critical Care
- Neurotrauma
Background:
- Severe traumatic brain injury (TBI) in children presents unique challenges in transfusion management.
- Defining massive transfusion (MT) is crucial for timely intervention and resource allocation in pediatric trauma.
- Existing MT definitions may not be optimal for pediatric populations with severe TBI.
Purpose of the Study:
- To establish an optimal definition for massive transfusion in pediatric trauma patients with severe TBI.
- To identify transfusion thresholds associated with mortality and the need for hemorrhage control procedures.
- To improve patient outcomes through better identification of patients requiring aggressive resuscitation.
Main Methods:
- Analysis of the 2015-2016 Trauma Quality Improvement Program (TQIP) research data sets.
- Inclusion criteria: children (age ≤18 years) with severe TBI who received blood products.
- Statistical analysis included descriptive statistics, Wilcoxon rank-sum, chi-square, and logistic regression with ROC curves to determine optimal thresholds.
Main Results:
- 460 children were included; overall mortality was 43%.
- Patients who died had lower Glasgow Coma Scores, higher rates of penetrating injury, and were more likely to be hypotensive.
- A threshold of 40 mL/kg/4-h of total blood products optimized sensitivity and specificity for predicting delayed mortality.
- A threshold of 50 mL/kg/4-h predicted the need for hemorrhage control procedures.
Conclusions:
- A massive transfusion threshold of 40 mL/kg/4-h is proposed for pediatric trauma with severe TBI.
- This threshold can effectively identify high-risk patients, potentially improving resource utilization.
- This definition can guide future research and clinical management strategies for pediatric TBI patients.
Background:
The purpose of this study was to identify an optimal definition of massive transfusion in civilian pediatric trauma with severe traumatic brain injury (TBI) METHODS: Severely injured children (age ≤18 y) with severe TBI in the Trauma Quality Improvement Program research data sets 2015-2016 that received blood products were identified. Data were analyzed using descriptive statistics, Wilcoxon rank-sum, chi-square, and logistic regression. Continuous variables are presented as median (interquartile range). Massive transfusion thresholds were determined based on receiver operating curves and optimization of sensitivity and specificity RESULTS: Of the 460 included children, the mortality rate was 43%. There were no differences in demographics, heart rate at presentation, or injury severity score between children that lived or died. However, those who died had lower Glasgow coma scores (3 [3, 8] versus 3 [3, 3]; P < 0.01), were more likely to have had a penetrating injury (20% versus 11%; P < 0.01) and were more likely to be hypotensive for age (62% versus 34%; P < 0.01). Total blood products infused were greater in those who died (34 mL/kg/4-h [17, 65] versus 22 [12, 44]; P < 0.01). Sensitivity and specificity for delayed mortality was optimized at 40 mL/kg/4 h, and for the need for a hemorrhage control procedure at 50 mL/kg/4 h. These thresholds predicted delayed mortality (OR 2.12; 95% CI 1.28-3.50; P < 0.01) and the need for hemorrhage control procedures (5.47; 95% CI 2.82-10.61; P < 0.01) CONCLUSIONS: For children with TBI, a massive transfusion threshold of 40 mL/kg/4-h of total administered blood products may be used to identify at-risk patients, improve resource utilization, and guide future research methodology.
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