Key Indicators Associated With Survival in Pediatric Trauma Massive Transfusion Protocol

Area of Science:

• Trauma Surgery
• Pediatric Critical Care
• Transfusion Medicine

Background:

• No established massive transfusion protocol (MTP) scoring system exists for pediatric trauma patients.
• This study evaluated factors associated with survival in pediatric trauma patients undergoing MTP.

Purpose of the Study:

• To identify predictors of survival in pediatric trauma patients requiring MTP.
• To inform the development of optimized MTP strategies for children.

Main Methods:

• Retrospective analysis of the National Trauma Data Bank (2017-2019) for pediatric patients (<18 years) receiving MTP (>40 mL/kg blood products within 4h).
• Exclusion of patients with non-survivable injuries or no signs of life on admission.
• Multivariable regression analysis to determine factors predictive of survival.

Main Results:

• Of 947 pediatric patients requiring MTP, 68% survived.
• Survival was associated with hemorrhage control surgery, tachycardia, and Level I trauma center presentation.
• Poor prognostic factors included hypothermia, severe Glasgow Coma Score (GCS), high Injury Severity Score (ISS), self-payment, and >80 mL/kg transfused blood products.

Conclusions:

• Tachycardia and Level I pediatric trauma centers are protective factors in MTP.
• Hypothermia, severe GCS, severe ISS, self-payment, and excessive blood product transfusion (>80 mL/kg) are associated with decreased survival.
• Development of predictive tools is crucial to guide MTP use and identify patients needing alternative interventions.