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Impact of Early Plasma Resuscitation in Pediatric Severe Traumatic Brain Injury
Leah Furman1, Erin V Feeney1, Barbara A Gaines2
1Department of Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA; Trauma and Transfusion Medicine Research Center, University of Pittsburgh, Keystone Building, 3520 Fifth Avenue, Suite 500, Pittsburgh, PA, 15213, USA.
Insights
Early plasma administration in children with severe traumatic brain injury (TBI) appears safe, with no significant difference in mortality compared to delayed administration. High mortality rates underscore the need for improved TBI therapies.
Area of Science:
- Pediatric critical care medicine
- Trauma surgery
- Neurocritical care
Background:
- Traumatic Brain Injury (TBI) is a primary cause of death in pediatric trauma cases.
- Early plasma administration is a potential intervention for severe TBI.
Purpose of the Study:
- To evaluate the safety of early plasma administration (within 4 hours) versus delayed administration (4-24 hours) in children with severe TBI.
- To assess the association between plasma timing and 28-day mortality.
Main Methods:
- Retrospective cohort study of children (<18 years) with severe TBI admitted to a Level 1 pediatric trauma center (2016-2023).
- Propensity matching was used to compare children receiving early plasma with those receiving delayed plasma.
- Adjusted logistic regression analyzed the impact of plasma timing on 28-day mortality.
Main Results:
- The study included 71 children with severe TBI; 31 received early plasma and 40 received delayed plasma.
- Among 31 propensity-matched pairs, early plasma administration was not significantly associated with 28-day mortality (OR 1.75, 95% CI: 0.42-7.31).
- No transfusion reactions or increased adverse events were observed with early plasma administration.
Conclusions:
- Early plasma administration in pediatric severe TBI is not associated with increased safety concerns.
- High overall mortality highlights the critical need for enhanced therapeutic strategies for severe pediatric TBI.
Background:
Traumatic Brain Injury (TBI) is the leading cause of traumatic pediatric mortality. This study examined the safety of early plasma administration in children with severe TBI.
Methods:
A retrospective cohort study using data from a Level 1 pediatric trauma center from 2016 to 2023 was conducted. Children <18 years old with severe TBI (head Abbreviated Injury Scale (AIS) > 2 and requiring ICU admission) who received component plasma within 24 h of injury were included. Isolated asphyxiation and neck trauma were excluded. Subjects who received "early" plasma (≤4 h from injury) were propensity matched for age, sex, admission GCS, shock, ISS, maximum head AIS, and injury mechanism with those who received "delayed" plasma (>4-24 h post-injury). Adjusted logistic regression on the matched cohort assessed the association between plasma timing and 28-day mortality.
Results:
Overall, 71 children met inclusion criteria; 31 received early and 40 received delayed plasma. The cohort was mostly male (66.2%) and injured via blunt mechanism (83.1%), with median(IQR) age 4(1-11) years, ISS 30(26-38), head AIS 5(4-5), and 28-day mortality rate of 62.0%. Among 31 propensity-matched pairs, there was no significant association between plasma timing and adjusted odds of 28-day mortality (Odds Ratio of early plasma 1.75 (95% CI: 0.42-7.31), p = 0.443), no transfusion reaction, and no increase in adverse events.
Conclusions:
In this study of children with severe TBI, there were no apparent safety concerns with the receipt of early plasma compared to delayed plasma. Overall mortality was high, demonstrating need for additional therapies for this vulnerable population.
Type Of Study:
Retrospective cohort study.
Level Of Evidence:
Level III.
