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What’s the Trigger to Activate Pediatric Massive Transfusion

October 18, 2022

Written by Vivian Lei

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A transfusion threshold of 20 ml/kg of any blood product during the first hour of pediatric trauma resuscitation maximizes sensitivity and specificity for in-hospital mortality, need for intervention, and additional bleeding episodes and may identify children in need of massive transfusion.

Why does this matter?
Life-threatening hemorrhage in children is challenging to identify due to unique injury patterns and compensatory physiology. Defining a critical administration threshold (CAT) may help predict massive transfusion needs and prevent poor outcomes.

CAT’s out of the bag on need for MTP
This retrospective cohort study of pediatric trauma patients at Level 1 urban trauma center included 287 children aged 0-17 years old who received any blood product transfusion within 24 hours after an injury. Median injury severity score was 26 (17-35) and 83% sustained blunt trauma. They found a critical administration threshold (CAT) of 20 ml/kg of blood product within one hour optimized sensitivity and specificity for mortality, need for urgent surgery, and subsequent bleeding. Children who were CAT+ (receiving >20 ml/kg) had significantly higher mortality (48% vs 22%), higher rates of functional disability at discharge (60% vs 46%), and required more transfusions. In multivariate regression analysis controlling for ISS, age, GCS, and hypotension, CAT+ patients had a 3.4 increased odds of mortality.

The authors present their defined CAT of 20 ml/kg as the upper limit of blood product administration, beyond which a massive transfusion protocol should be activated. Prospective studies are needed to validate this finding.

Recognizing Life-Threatening Bleeding in Pediatric Trauma: A Standard for When to Activate Massive Transfusion Protocol. J Trauma Acute Care Surg. 2022 Sep 19. doi: 10.1097/TA.0000000000003784. Online ahead of print.

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