Are All Children Created Alike? Differences in MTP Across Three Age Groupings (0–5, 6–12, & 13–17)

Introduction—Hemorrhage due to trauma is a leading cause of death in pediatric patients. Massive transfusion protocols (MTPs) potentially reduce mortality in pediatric trauma patients, but triggers for MTP activation are ill-defined.

Objective—To characterize pediatric trauma patients requiring transfusion in the first 24 hours to evaluate potential triggers for MTP and transfusion in the prehospital setting.

Methods—Using a Level I trauma center’s registry, all pediatric trauma patients (0–17) from January 2015 to August 2017 who required transfusion in the first 24 hours of their stay were selected. Patients were categorized by age: 0–5, 6–12, and 13–17 years old. Several variables were studied using the independent samples t-test and chi-square test to assess for differences between survivors and nonsurvivors.

Results—The all-cause mortality was 26% (18/70), with 22% (4/18) of deaths due to bleeding. The odds of death were higher for blunt trauma compared to penetrating (OR 1.19; 95% CI, 0.79–1.81). Eighteen patients received massive transfusion, 78% (14/18) of whom were of adolescent age (13–17 years old). The mortality rate in the adolescent group was 21% (7/33) despite a higher pulse pressure in the adolescent patients who died. Of note, prehospital times were routinely longer than 60 minutes.

Conclusion—Despite not finding any valid transfusion triggers, the prolonged prehospital time, high mortality rate, and need for massive transfusion in this study support the inclusion of adolescent patients in prehospital whole blood transfusion programs.