Avoiding unnecessary massive transfusion protocol activation in paediatric trauma: Development of the activation of...

Massive transfusion protocols (MTPs) are essential for timely resuscitation in trauma but carry the risks of blood product wastage and strain on transfusion services. Existing adult-based scoring systems are unreliable in paediatric populations. This study aimed to develop and validate a paediatric-specific scoring system to guide MTP activation.

This is a retrospective cohort study using the 2018 National Trauma Data Bank. Paediatric trauma patients aged 1-15 years were included. The primary outcome was the need for massive transfusion, defined as >40 mL/kg of blood product within 4 h of admission. Multivariable logistic regression identified the predictors to develop the activation of massive transfusion in children (AMTC) score. The model was evaluated in an independent validation cohort.

Among the 668 participants, the median age was 9 years, median weight was 34 kg and median Abbreviated Injury Scale score was 5. Within 4 h of admission, participants received a median of 27 mL/kg of blood products, and 222 patients (34%) received more than 40 mL/kg. Four factors independently predicted the need for massive transfusion, which were incorporated into the AMTC score: age, penetrating trauma, initial temperature and requiring surgery for haemorrhagic control. Using a cutoff of >2, the positive and negative predictive values were 46% and 83%, respectively.

The AMTC score provides a simple tool to identify paediatric trauma patients at risk of requiring massive transfusion. Its strong negative predictive value may help avoid unnecessary MTP activation, reduce blood product waste and alleviate blood banks' operational burden.