Massive transfusion in pediatric trauma: An ATOMAC perspective

Daniel K. Noland, Nadja Apelt, Cynthia Greenwell, Jefferson Tweed, David M. Notrica, Nilda Garcia, R. Todd Maxson, James W. Eubanks, Adam C. Alder

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background/Purpose: Massive transfusion protocols (MTPs) are considered valuable in pediatric trauma. Important questions regarding the survival benefit and optimal blood component ratio remain unknown. Methods: The study time frame was January 2007 through December 2013 five Level I Pediatric Trauma Centers reviewed all trauma activations involving children ≤ 18 years of age. Included were patients who either had the institutional MTP or received > 20 mL/kg or > 2 units packed red blood cells (PRBCs). Results: 110/202 qualified for inclusion. Median age was 5.9 years (3.0–11.4). 73% survived to discharge; median hospitalization was 10 (3.1–22.8) days. Survival did not vary by arrival hemoglobin (Hgb), gender or age. Partial prothrombin time (PTT), INR, GCS and injury severity score (ISS) significantly differed for nonsurvivors (all p < 0.05). Logistic regression found increased mortality (OR 3.08 (1.10–8.57), 95% CI; p = 0.031) per unit increase over a 1:1 ratio of pRBC:FFP. Conclusion: In pediatric trauma pRBC:FFP ratio of 1:1 was associated with the highest survival of severely injured children receiving massive transfusion. Ratios 2:1 or ≥ 3:1 were associated with significantly increased risk of death. These data support a higher proportion of plasma products for pediatric trauma patients requiring massive transfusion. Level of evidence: Level IV.

Original languageEnglish (US)
Pages (from-to)345-349
Number of pages5
JournalJournal of Pediatric Surgery
Volume54
Issue number2
DOIs
StatePublished - Feb 1 2019

Fingerprint

Pediatrics
Wounds and Injuries
Survival
Injury Severity Score
International Normalized Ratio
Trauma Centers
Prothrombin Time
Hemoglobins
Hospitalization
Erythrocytes
Logistic Models
Mortality

Keywords

  • Pediatric massive transfusion
  • Trauma resuscitation

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Noland, D. K., Apelt, N., Greenwell, C., Tweed, J., Notrica, D. M., Garcia, N., ... Alder, A. C. (2019). Massive transfusion in pediatric trauma: An ATOMAC perspective. Journal of Pediatric Surgery, 54(2), 345-349. https://doi.org/10.1016/j.jpedsurg.2018.10.040

Massive transfusion in pediatric trauma : An ATOMAC perspective. / Noland, Daniel K.; Apelt, Nadja; Greenwell, Cynthia; Tweed, Jefferson; Notrica, David M.; Garcia, Nilda; Todd Maxson, R.; Eubanks, James W.; Alder, Adam C.

In: Journal of Pediatric Surgery, Vol. 54, No. 2, 01.02.2019, p. 345-349.

Research output: Contribution to journalArticle

Noland, DK, Apelt, N, Greenwell, C, Tweed, J, Notrica, DM, Garcia, N, Todd Maxson, R, Eubanks, JW & Alder, AC 2019, 'Massive transfusion in pediatric trauma: An ATOMAC perspective', Journal of Pediatric Surgery, vol. 54, no. 2, pp. 345-349. https://doi.org/10.1016/j.jpedsurg.2018.10.040
Noland, Daniel K. ; Apelt, Nadja ; Greenwell, Cynthia ; Tweed, Jefferson ; Notrica, David M. ; Garcia, Nilda ; Todd Maxson, R. ; Eubanks, James W. ; Alder, Adam C. / Massive transfusion in pediatric trauma : An ATOMAC perspective. In: Journal of Pediatric Surgery. 2019 ; Vol. 54, No. 2. pp. 345-349.
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