Tranexamic acid in pediatric combat trauma requiring massive transfusions and mortality

Area of Science:

• Trauma Surgery
• Pediatric Critical Care
• Emergency Medicine

Background:

• Tranexamic acid (TXA) is known to reduce mortality in adult trauma patients, especially those requiring massive transfusions.
• Limited data exist on TXA efficacy in pediatric trauma patients, particularly in combat settings.

Purpose of the Study:

• To evaluate the effectiveness of TXA in reducing in-hospital mortality among pediatric trauma patients requiring massive transfusions.
• To analyze secondary outcomes such as hospital, ventilator, and ICU-free days, and total blood product volume.

Main Methods:

• Retrospective cohort study using the Department of Defense Trauma Registry.
• Included pediatric patients (<18 years) from Iraq and Afghanistan requiring ≥40 mL/kg blood product within 24 hours.
• Excluded burns and fatal head traumas; primary outcome was in-hospital mortality.

Main Results:

• TXA recipients had lower in-hospital mortality (8.5% vs. 18.3%), though not statistically significant (p=0.055).
• Logistic regression showed TXA significantly reduced odds of death (OR 0.35; p=0.0488).
• Secondary outcomes (hospital, ventilator, ICU-free days) and blood product volumes were similar between groups.

Conclusions:

• TXA administration in pediatric combat trauma patients requiring massive transfusions trended towards improved in-hospital mortality.
• Findings align with adult trauma studies and suggest a potential mortality benefit for TXA in this population.