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Association Between Whole Blood Transfusion and Mortality Among Injured Pediatric Patients
Makoto Aoki1, Morihiro Katsura2,3, Kazuhide Matsushima3
1Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan.
Insights
Whole blood (WB) transfusions in injured children requiring immediate transfusion were linked to better survival rates. This study found WB significantly reduced mortality risk at both 24 hours and 30 days post-transfusion.
Area of Science:
- Pediatric Trauma Care
- Transfusion Medicine
- Emergency Medicine
Background:
- Whole blood (WB) transfusion is increasingly considered for trauma patients.
- While studies show improved survival in adults, evidence in pediatric trauma is limited.
- This research addresses the gap in understanding WB's impact on pediatric trauma survival.
Purpose of the Study:
- To evaluate the association between whole blood (WB) transfusion and mortality in injured children.
- To determine if WB transfusion improves survival outcomes in pediatric trauma patients needing immediate transfusion.
Main Methods:
- Retrospective cohort study using the ACS-TQIP database (2020-2021).
- Included pediatric patients (≤16 years) receiving immediate transfusion within 4 hours of arrival.
- Propensity score matching (1:1) was used to compare survival at 24 hours and 30 days between WB and component therapy groups.
Main Results:
- 319 (11.7%) of 2729 eligible pediatric patients received WB.
- After propensity score matching, WB transfusion was associated with a 42% lower risk of mortality at 24 hours (HR 0.58, P=0.042).
- A significant survival benefit was also observed at 30 days (HR 0.65, P=0.011).
Conclusions:
- Whole blood transfusion is associated with improved survival in pediatric trauma patients requiring immediate transfusion.
- Findings support the consideration of WB for immediate transfusion in critically injured children.
- Further research may elucidate optimal protocols for WB use in pediatric trauma.
Objective:
The aim of this study was to assess the association between whole blood (WB) and mortality among injured children who received immediate blood transfusion.
Background:
The use of WB for transfusion therapy in trauma has been revisited, and recent studies have reported an association between WB and improved survival among adults. However, evidence of a similar association lacks in children.
Methods:
We performed a retrospective cohort study from the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) between 2020 and 2021. Patients were aged less than or equal to 16 years and had immediate blood transfusion within 4 hours of hospital arrival. Survival at 24 hours and 30 days were compared after creating 1:1 propensity score-matched cohorts, matching for demographics, injury type, vital signs on admission, trauma severity scores, hemorrhage control procedures, hospital characteristics, and the need for massive transfusion.
Results:
A total of 2729 patients were eligible for analysis. The median age was 14 years (interquartile range: 8-16 years); 1862 (68.2%) patients were male; and 1207 (44.2%) patients were White. A total of 319 (11.7%) patients received WB. After a 1:1 ratio propensity score matching, 318 matched pairs were compared. WB transfusion was associated with improved survival at 24 hours, demonstrating a 42% lower risk of mortality (hazard ratio, 0.58; 95% CI, 0.34-0.98; P =0.042) Similarly, the survival benefit associated with WB transfusion remained consistent at 30 days (hazard ratio, 0.65; 95% CI, 0.46-0.90; P =0.011).
Conclusion:
The use of WB was associated with improved survival among injured pediatric patients requiring immediate transfusion.
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