Recognizing life-threatening bleeding in pediatric trauma: A standard for when to activate massive transfusion...

Area of Science:

• Pediatric Trauma Care
• Hemorrhagic Shock Management
• Massive Transfusion Protocols

Background:

• Traumatic hemorrhage is a leading cause of preventable death in pediatric trauma.
• Early identification of life-threatening hemorrhage in children is challenging.
• No established clinical critical administration threshold (CAT) exists for pediatric massive transfusion protocols.

Purpose of the Study:

• To establish a clinical critical administration threshold (CAT) for activating massive transfusion protocols in pediatric trauma patients.
• To identify a specific volume of blood products transfused within an hour that predicts adverse outcomes in children.

Main Methods:

• Retrospective analysis of pediatric trauma patients (0-17 years) who received transfusions within 24 hours (2010-2019).
• Calculated greatest volume of weight-adjusted blood products transfused within 1 hour.
• Determined optimal cutoff using Youden's index to predict mortality, urgent surgery, and re-bleeding.

Main Results:

• The optimal CAT was identified as >20 mL/kg of blood products within 1 hour.
• This threshold predicted in-hospital mortality with 70% sensitivity and 77% specificity.
• Patients meeting the CAT had 3.4 times increased odds of mortality and a 10% increased risk per unit transfused.

Conclusions:

• A threshold of >20 mL/kg of any blood product within an hour should trigger massive transfusion protocols in children.
• Pediatric patients meeting this CAT are at high risk for mortality and require interventions.
• Targeted, timely, and aggressive hemostatic resuscitation is recommended for pediatric CAT+ patients.