To give or not to give? Blood for pediatric trauma patients prior to pediatric trauma center arrival

• DOI: 10.1007/s00383-021-05015-9
• Publication Date: 2021-10-05T03:15:26Z
• Authors: Gabrielle Shirek; Ryan Phillips; Niti Shahi; Kaci Pickett; Maxene Meier; John Recicar; Steven L. Moulton
• Keywords: Pediatric trauma; Trauma Center; Arrival time

This study evaluates the indications, safety and clinical outcomes associated with the administration of blood products prior to arrival at a pediatric trauma center (prePTC).Children (≤ 18 years) who were highest level activations at an ACS level 1 pediatric trauma center (PTC) from 2009-2019 were divided into groups:(1) patients with transport times < 4 h who received blood prePTC(preBlood) versus (2) age matched controls with transport times < 4 h who only received crystalloid prePTC (preCrystalloid).Of 1269 trauma activations, 38 met preBlood and 38 met preCrystalloid inclusion criteria. A similar volume of prePTC crystalloid infusion was observed between cohorts (p = 0.311). PreBlood patients evidenced greater hemodynamic instability as demonstrated by higher prePTC pediatric age-adjusted shock index (SIPA) scores. PreBlood patients showed improvement in lactate (p = 0.038) and hemoglobin (p = 0.041) levels upon PTC arrival. PreBlood patients received less crystalloid within 12 h of PTC admission (p = 0.017). No significant differences were found in blood transfusion volumes within six (p = 0.293) and twenty-four (p = 0.575) hours of admission, nor in mortality between cohorts (p = 0.091).The administration of blood to pediatric trauma patients prior to arrival at a PTC is safe, transiently improves markers of shock, and was not associated with worse outcomes.