Coagulopathy and transfusion ratios in pediatric trauma

Coagulopathy has been associated with poor outcomes in adult and pediatric trauma. Previous clinical trials have shown benefits with balanced transfusion ratios in trauma resuscitation in adults, but smaller retrospective studies have not established the same in pediatrics. We constructed a pediatric trauma database at a Level I trauma center for analysis.

The institutional trauma registry was queried for all pediatric trauma activations from 2008 to 2018. Patient identifiers were used to identify laboratory data from the electronic data warehouse.

There were 2,769 pediatric patients with trauma identified, with 1,492 arriving direct from the scene. Of those with complete transport data available, 81% arrived within 60 minutes from time of injury. Fifty-two patients were transfused in the first 24 hours, with 25 receiving greater than an estimated 40 mL/kg of blood products. No significant difference in ratios of red cell to plasma transfused at 24 hours was observed between patients surviving to discharge (1.4; 95% confidence interval, 1.0-1.6) and deceased (1.7; 95% confidence interval, 1.4-1.9) (p = 0.087).Among direct admissions, an abnormal prothrombin time or partial thromboplastin time taken within 2 hours of arrival was significantly associated with in-hospital mortality (p = 0.003 and <0.001), but no significant associations were seen for abnormal fibrinogen or platelet counts. Red cell to plasma transfusion ratios were not significantly associated with length of stay or ventilator days (p = 0.74 and 0.28).

There was no significant difference between transfusion ratios of surviving and deceased patients at 3- and 24-hour time points, including in a weight-adjusted highly transfused subgroup. Coagulopathy remains an important issue in pediatric trauma and may guide future multicenter studies in optimizing transfusion ratios in pediatric trauma.

Retrospective comparative study, level III.