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Consensus-based criteria for actionable hemorrhage in pediatric trauma: A Delphi study.
The Journal of Trauma and Acute Care Surgery
|March 25, 2026
Summary
New criteria help identify severe bleeding in pediatric trauma patients. These guidelines aid clinicians in determining actionable hemorrhage, improving care for critically injured children.
Area of Science:
- Pediatric Trauma Care
- Hemorrhage Management
- Clinical Criteria Development
Background:
- Current methods for identifying severe bleeding in pediatric trauma are unreliable.
- This can lead to unnecessary transfusions or delayed interventions.
- Standardized criteria are needed to define actionable hemorrhage.
Purpose of the Study:
- To establish expert consensus criteria for identifying actionable hemorrhage in injured children.
- Focus on events within 6 hours of emergency department arrival.
Main Methods:
- Modified Delphi study involving experts from six pediatric trauma specialties.
- Defined actionable hemorrhage as severe bleeding or injury risking shock progression without intervention.
- Achieved consensus using a five-point strength-of-indication scale and statistical analysis.
Main Results:
- Thirteen criteria achieved stable expert consensus as strong indicators of actionable hemorrhage.
- Highest agreement for criteria included organ resection for bleeding, hemoglobin < 6 g/dL, and resuscitative thoracotomy/sternotomy.
- No criteria reached consensus as weak indicators.
Conclusions:
- Expert consensus criteria for actionable hemorrhage in pediatric trauma have been established.
- These criteria identify strong indicators of severe bleeding requiring intervention or leading to death.
- Prospective validation of these criteria is recommended.
