Contributions
Abstract: EP1342
Type: E-Poster Presentation
Session title: Transfusion medicine
Background
Trauma is the leading cause of preventable death in children. Severely injured cases may require transfusion of blood products but no consensus exists regarding optimal blood product use and clear indications for pediatric massive transfusion (MT) activation.
Aims
In this study, it was aimed to investigate clinical and laboratory data, management, and outcomes of pediatric trauma patients who initially received blood product transfusion.
Methods
Children aged 0 to 18 years who presented to the pediatric emergency department due to trauma and underwent and blood product transfusion within 24 hours of arrival between January 2011 and January 2021 were included. Demographics, initial vital signs, clinical findings, laboratory, and radiologic results were recorded. Injury Severity Score (ISS), total volume of transfused blood products and crystalloid boluses in 24 hours were calculated. Patients were divided into two groups according to the fresh frozen plasma (FFP): packed red blood cell (PRBC) ratio: low ratio group as <1:2 and high ratio group as ≥1:2. Massive transfusion was defined as transfusion of ≥40 mL/kg of all blood products in 24 hours. Length of stay in the pediatric intensive care unit (PICU), stay in the hospital and 30-day mortality were recorded.
Results
Thirty-two patients [median age 8.8 years (IQR 2.0-15.1), 20 males (62.5%)] were enrolled. In addition to crystalloid boluses and PRBC transfusion, 19 (59.3%) cases received FFP and among them, 12 cases were transfused with high and 7 cases with low FFP: PRBC ratio. Eight (25.0%) patients met MT threshold criteria. Length of PICU stay, length of mechanical ventilation (MV) and transfusion complication rates were higher for cases who received MT although there was no difference for age, ISS scores, the volume of crystalloid boluses, length of hospital stay, and 4 h, 24 h or 30-day mortality between MT (+) and (-) groups. Children who received transfusion with a high FFP: PRBC ratio were older in age and had a higher ISS score than those who received a low ratio but there was no difference for length of hospital stay or mortality rates between groups. Total volume of crystalloid boluses was higher in patients who died than those who survived but the volume of blood products was similar for two groups. To predict 30-day mortality, multivariable analysis was performed and among parameters of a Glasgow Coma Scale (GCS) score of ≤8, an ISS score of ≥25, having received MT and crystalloid bolus ≥40 mL/kg, a GCS score of ≤8 was identified as a predictor (OR = 21.700, 95% CI: 1.951-243.498, p: 0.012). When we added activated partial thromboplastin time (APTT) to these parameters, then an APTT value of >37.5 seconds was identified as a predictor of 30-day mortality (OR = 48.000, 95% CI: 3.704-621.998, p: 0.003), respectively.
Conclusion
Children who received MT had longer duration of MV and PICU stay, and higher transfusion complication rates than those who did not receive but there was no significance for ISS scores, the volume of crystalloid boluses, hospital stay or mortality between two groups. Total volume of crystalloid boluses was higher in patients who resulted in death than those who survived although the volume of blood products was similar for two groups. The GCS score and APTT can be used to predict 30-day mortality in pediatric trauma patients.
Keyword(s): Erythrocyte, Platelet transfusion, Transfusion, Trauma
Abstract: EP1342
Type: E-Poster Presentation
Session title: Transfusion medicine
Background
Trauma is the leading cause of preventable death in children. Severely injured cases may require transfusion of blood products but no consensus exists regarding optimal blood product use and clear indications for pediatric massive transfusion (MT) activation.
Aims
In this study, it was aimed to investigate clinical and laboratory data, management, and outcomes of pediatric trauma patients who initially received blood product transfusion.
Methods
Children aged 0 to 18 years who presented to the pediatric emergency department due to trauma and underwent and blood product transfusion within 24 hours of arrival between January 2011 and January 2021 were included. Demographics, initial vital signs, clinical findings, laboratory, and radiologic results were recorded. Injury Severity Score (ISS), total volume of transfused blood products and crystalloid boluses in 24 hours were calculated. Patients were divided into two groups according to the fresh frozen plasma (FFP): packed red blood cell (PRBC) ratio: low ratio group as <1:2 and high ratio group as ≥1:2. Massive transfusion was defined as transfusion of ≥40 mL/kg of all blood products in 24 hours. Length of stay in the pediatric intensive care unit (PICU), stay in the hospital and 30-day mortality were recorded.
Results
Thirty-two patients [median age 8.8 years (IQR 2.0-15.1), 20 males (62.5%)] were enrolled. In addition to crystalloid boluses and PRBC transfusion, 19 (59.3%) cases received FFP and among them, 12 cases were transfused with high and 7 cases with low FFP: PRBC ratio. Eight (25.0%) patients met MT threshold criteria. Length of PICU stay, length of mechanical ventilation (MV) and transfusion complication rates were higher for cases who received MT although there was no difference for age, ISS scores, the volume of crystalloid boluses, length of hospital stay, and 4 h, 24 h or 30-day mortality between MT (+) and (-) groups. Children who received transfusion with a high FFP: PRBC ratio were older in age and had a higher ISS score than those who received a low ratio but there was no difference for length of hospital stay or mortality rates between groups. Total volume of crystalloid boluses was higher in patients who died than those who survived but the volume of blood products was similar for two groups. To predict 30-day mortality, multivariable analysis was performed and among parameters of a Glasgow Coma Scale (GCS) score of ≤8, an ISS score of ≥25, having received MT and crystalloid bolus ≥40 mL/kg, a GCS score of ≤8 was identified as a predictor (OR = 21.700, 95% CI: 1.951-243.498, p: 0.012). When we added activated partial thromboplastin time (APTT) to these parameters, then an APTT value of >37.5 seconds was identified as a predictor of 30-day mortality (OR = 48.000, 95% CI: 3.704-621.998, p: 0.003), respectively.
Conclusion
Children who received MT had longer duration of MV and PICU stay, and higher transfusion complication rates than those who did not receive but there was no significance for ISS scores, the volume of crystalloid boluses, hospital stay or mortality between two groups. Total volume of crystalloid boluses was higher in patients who resulted in death than those who survived although the volume of blood products was similar for two groups. The GCS score and APTT can be used to predict 30-day mortality in pediatric trauma patients.
Keyword(s): Erythrocyte, Platelet transfusion, Transfusion, Trauma