Defining massive transfusion in civilian pediatric trauma

Area of Science:

• Pediatric Trauma Care
• Transfusion Medicine
• Emergency Medicine

Background:

• Defining massive transfusion (MT) is crucial for timely intervention in pediatric trauma.
• Existing definitions may not optimally capture the severity of hemorrhage in children.

Purpose of the Study:

• To identify an optimal definition for massive transfusion (MT) in civilian pediatric trauma.
• To establish a transfusion threshold that predicts critical outcomes.

Main Methods:

• Analysis of severely injured children (age ≤18 years, ISS ≥25) from the 2014-2015 Trauma Quality Improvement Program.
• Exclusion of patients with traumatic brain injury or non-survivable injuries.
• Utilized receiver operating characteristic curves and sensitivity/specificity analysis to determine the MT threshold.

Main Results:

• An optimal threshold of 37 mL/kg transfused blood products within 4 hours was identified for predicting early mortality.
• This 37 mL/kg/4h threshold significantly predicted the need for hemorrhage control procedures (OR 8.60) and early mortality (OR 4.24).
• Overall mortality in the study cohort was 27%.

Conclusions:

• A massive transfusion protocol (MTP) threshold of 37 mL/kg/4h effectively predicts hemorrhage control needs and early mortality in pediatric trauma.
• This definition offers a timely prognostic indicator for clinicians.
• The proposed threshold can enhance research methodology and optimize resource allocation in pediatric trauma care.