Massive transfusion in pediatric trauma-does more blood predict mortality?

Area of Science:

• Pediatric trauma critical care
• Hemorrhage management
• Massive transfusion protocols

Background:

• Severe hemorrhage management relies on bleeding control and volume expansion via massive transfusion (MT).
• Assessing transfusion volume's impact on mortality in pediatric trauma is crucial for optimizing care.

Purpose of the Study:

• To determine if transfusion volumes in pediatric trauma patients receiving MT correlate with increased mortality risk.
• To identify potential thresholds for futile resuscitation with blood products.

Main Methods:

• Analysis of 633 pediatric trauma patients (2-18 years) from the 2014-2017 Trauma Quality Improvement Program (TQIP) database meeting MT criteria (40 mL/kg/24h).
• Data cleaning to ensure accuracy of blood volume reporting.
• Receiver operating characteristic (ROC) curve analyses to calculate area under the curve (AUC) for mortality prediction.

Main Results:

• Overall mortality rate was 21.6% among the 633 patients.
• Transfusion volume showed poor predictive value for both early and late mortality (AUC ≈ 0.50).
• No specific transfusion volume reliably predicted a high mortality rate across different injury mechanisms.

Conclusions:

• No upper transfusion volume threshold predicts mortality in pediatric trauma patients undergoing massive transfusion.
• Severely injured children demonstrate a capacity to tolerate substantial volumes of blood products and survive.