Not as simple as ABC: Tools to trigger massive transfusion in pediatric trauma

Area of Science:

• Pediatric Trauma Care
• Emergency Medicine
• Diagnostic Accuracy

Background:

• Early identification of pediatric trauma patients requiring massive transfusion (MT) is challenging.
• Existing methods lack established accuracy for predicting MT in children.
• Novel scoring systems are needed to guide transfusion protocols.

Purpose of the Study:

• To develop and validate scoring systems for predicting MT in pediatric trauma patients.
• To compare the predictive performance of the ABCD score and the BIS score.
• To establish a simple bedside tool for MT triggering.

Main Methods:

• Retrospective review of pediatric trauma patients (≤18 years) from 2008-2019.
• Development of ABCD score (mechanism, FAST, SIPA, lactate, BD) and BIS score (BD, INR, SIPA).
• Receiver operator curve analysis to determine cutoff points and assess sensitivity, specificity, and accuracy for MT prediction.

Main Results:

• 772 patients included; 59 (7.6%) received MT.
• BIS score (≥2) demonstrated 98% sensitivity and 23% specificity (AUC 0.81).
• ABCD score (≥2) showed 97% sensitivity and 20% specificity (AUC 0.77).

Conclusions:

• The BIS score is a highly sensitive and accurate tool for predicting MT in pediatric trauma.
• The BIS score integrates key indicators of acidosis, coagulopathy, and SIPA.
• It offers a practical bedside screening method for initiating massive transfusion protocols.