Outcomes in Pediatric Trauma Patients Who Receive Blood Transfusion

Research study background

Hemorrhage is the most common cause of preventable death in pediatric trauma patients. Massive transfusions can reduce these preventable deaths, but blood transfusion has known risks for infections and non-infectious complications. Massive transfusion protocols in adults help prevent complications and improve outcomes but have not been well-studied in pediatric patients. Research indicates there are differences in age-related physiological changes between pediatric and adult patients and that the volume of transfused blood product does not impact mortality outcomes in pediatric patients.

Steven Moulton, MD, pediatric trauma surgeon and director of the Trauma Program at Children’s Hospital Colorado, and researchers from Children’s Colorado’s Center for Children’s Surgery led this study. Their two main goals were to evaluate associations between massive transfusion and outcomes in these patients and determine if age resulted in differences in massive transfusion outcomes.

Pediatric data from the Trauma Quality Improvement Program between 2015 and 2018 were used to create the analytic cohort, which was stratified by massive transfusion (MT) status:

• 1,159 MT+ patients, or those who received massive transfusion (blood product volume of 40 mL/kg within 24 hours of admission), were matched with 1,159 MT- patients, or those who did not did not meet MT threshold
• 50.9% sustained a blunt injury
• 9 years old median patient age
• 39.9 median volume of blood products patients received over 24 hours

When comparing the two cohorts, MT+ patients experienced higher rates of intubation, deep venous thrombosis, acute kidney injury, CLABSI and severe sepsis. Logistic regression found massive transfusion was an independent risk factor for these outcomes, but there was not an age-based differential effect.

Study conclusions

• Low incidence of known adverse outcomes linked with blood transfusion and MT in pediatric patients
• Increased blood volume in patients who receive MT+ is independently linked with higher risk of adverse outcomes
• No differences in outcomes for patients who receive MT+ based on age