Defining Massive Transfusion for Pediatric Trauma Resuscitations

Published in J Trauma Acute Care Surg 2015 Jan 78:22

Authors: Neff LP et al.

Children who received >40 mL/kg of total blood products within 24 hours were at increased risk for death.

To define massive transfusion for the pediatric population and thus aid future development of pediatric-specific trauma resuscitation protocols, investigators retrospectively reviewed outcomes of children who presented to U.S. combat hospitals in Iraq and Afghanistan with traumatic injuries and required any blood products (whole blood, packed red blood cells, fresh frozen plasma, platelets, or cryoprecipitate) within 24 hours. Children with severe isolated or predominant head injuries were excluded. The study included 1113 children (median age, 10 years) who presented from 2001 to 2013.

Using sensitivity and specificity plots for 24-hour and in-hospital mortality, the authors identified 40 mL/kg of blood products as the optimal cut-off for defining massive transfusion. Compared to children who received <40mL/kg of total blood products, those who received ≥40 mL/kg of total blood products had higher 24-hour mortality (2% vs. 5%) and in-hospital mortality (6% vs.15%). In a multivariate logistic regression analysis, the 24-hour and in-hospital odds of death for children who received ≥40 mL/kg of total blood products were 2.5 and 2.6, respectively.

Comment
Pediatric trauma patients who receive ≥40 mL/kg of total blood products are at increased mortality risk. Until more evidence-based pediatric-specific protocols are developed, providers should use lessons learned from the adult literature, which has demonstrated benefit from balancing resuscitations with red blood cells, platelets, and plasma.