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Pediatric Massive Transfusion Protocol: A Narrative Review and Proposed Algorithm
Michaela Forgione1, Nicholas J Larson1, Amelia Collings2
1Department of Surgery, Regions Hospital, Saint Paul, MN, USA.
The American Surgeon
|November 20, 2025
Summary
Hemorrhage is a major cause of death, especially in children. This review examines pediatric massive transfusion protocols (pMTP) and proposes an algorithm for pMTP activation due to limited research.
Area of Science:
- Trauma Surgery
- Pediatric Critical Care
- Hemorrhagic Shock Management
Background:
- Hemorrhage is a leading cause of preventable death in the US.
- Pediatric patients have a disproportionately high mortality rate from hemorrhage.
- Literature on pediatric trauma resuscitation and massive transfusion protocols (MTP) is less developed than for adults.
Purpose of the Study:
- To review the current literature on pediatric massive transfusion protocols (pMTP).
- To identify the state of research regarding pMTP.
- To provide a framework for pMTP activation in pediatric trauma.
Main Methods:
- Systematic literature review of pediatric MTP.
- Development of a clinical algorithm by content experts in trauma and pediatric surgery.
- Assessment of existing evidence and identification of research gaps.
Main Results:
- The current literature on pMTP is limited.
- An expert-developed algorithm for pMTP activation is proposed.
- A need for a validated scoring system for pMTP activation in pediatric patients is identified.
Conclusions:
- Further research is needed to establish evidence-based pMTP guidelines.
- The proposed algorithm serves as an interim solution for pMTP activation.
- Standardized and validated protocols are crucial for improving outcomes in pediatric trauma resuscitation.
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