Missed Opportunities for Prehospital Transfusion in Pediatric Trauma

Prehospital blood transfusion has been associated with improved outcomes among pediatric trauma patients, but its utilization nationally remains poorly understood. We recently conducted a similar study that builds upon the findings of the investigation by Ramgopal et al. to identify potential missed opportunities for prehospital transfusion in pediatric trauma.

We utilized the National EMS Information System dataset from 2018-2023 to identify emergency medical services (EMS) responses for pediatric (<18 years of age) trauma patients. We identified trauma patients using the CDC Injury Mortality Diagnosis Matrix related ICD-10 codes. We identified patients at increased risk of benefiting from a transfusion using age-adjusted positive shock index thresholds. The outcome of interested was prehospital blood or blood product transfusion.

We found there were 1,663,601 total 9-1-1 EMS activations to a scene for pediatric trauma. There were 363,844 patients with a positive shock index who were considered to be at increased risk of benefiting from a prehospital transfusion, but only 287 (0.1%) of these patients received a prehospital transfusion. Only 10 (2%) of the 468 patients who experienced a cardiac arrest after the arrival of EMS to the scene received a hospital transfusion.

Together, our results indicate prehospital transfusion rates ranging from 0.1% to 1.01% among potentially eligible pediatric trauma patients. Although positive shock index does not confirm hemorrhagic shock, these findings suggest underutilization of prehospital blood transfusion among pediatric trauma patients.