Variables Associated with the Receipt of Blood Transfusions Among Critical Pediatric Trauma Patients at a Single Level 1 Trauma Center, Houston, Texas - 2011 to 2016

Abstract

Massive blood loss due to trauma requires faster recognition and treatment using established protocols to prevent death. Currently, adult guidelines are used for pediatric patients. This is not an optimal approach due to differences in blood volume, physiology, and body weight between adults and children. The lack of consistency in the indicators used in hospital massive transfusion protocols must be addressed in order to improve treatment for critically injured pediatric trauma patients. Cases of critical pediatric trauma patients (17 years and younger) from 2011 to 2016 were retrospectively analyzed from Memorial Hermann Texas Medical Center. Patients given blood products within 24 hours of injury were evaluated. Descriptive profiles were constructed through bivariate and means analysis that generated descriptive statistics for patient population explanation. Spearman correlations, Mann-Whitney tests, and Kruskal-Wallis tests were conducted to determine associations between demographic and clinical indicators and patient mean arterial pressures. Of the 397 cases, critical pediatric trauma patients who received blood products in the prehospital or in-hospital environment were more likely to have been intubated (odds ratio = 1.61; 95% confidence interval: 1.04, 2.51); more likely to have lower mean arterial pressures (mean arterial pressure ≤ 59: odds ratio = 4.04; 95% confidence interval: 1.95, 8.37); more likely to have lower systolic blood pressures (systolic blood pressure ≤ 89: odds ratio = 3.69; 95% confidence interval: 2.02, 6.76); and more likely to have lower heart rates (heart rate ≤ 59: odds ratio = 5.12; 95% confidence interval: 1.67, 15.70) compared to patients not given blood products. Critical pediatric trauma patients who received prehospital blood products came directly from emergency scenes, were preteenagers, were more frequently intubated, and had lower heights, weights, mean arterial pressures, systolic blood pressures, and heart rates than critical pediatric trauma patients who received blood products in-hospital. Critical pediatric trauma patient mean arterial pressures showed a moderate overall correlation with age, weight, and height. Profiled critical pediatric trauma patients show that mean arterial pressure, intubation, heart rate, height, weight, systolic blood pressure, and lack of severe head injury are associated with blood transfusion and prehospital blood transfusion. More research is needed to determine more appropriate factors associated with critical pediatric trauma patient massive transfusion protocol and prehospital treatment.