Experience in an Urban Level 1 Trauma Center With Tranexamic Acid in Pediatric Trauma: A Retrospective Chart Review

Abstract

Background: Evidence for tranexamic acid (TXA) in the pharmacologic management of trauma is largely derived from data in adults. Guidance on the use of TXA in pediatric patients comes from studies evaluating its use in cardiac and orthopedic surgery. There is minimal data describing TXA safety and efficacy in pediatric trauma. The purpose of this study is to describe the use of TXA in the management of pediatric trauma and to evaluate its efficacy and safety end points. Methods: This retrospective, observational analysis of pediatric trauma admissions at Hennepin County Medical Center from August 2011 to March 2019 compares patients who did and did not receive TXA. The primary end point is survival to hospital discharge. Secondary end points include surgical intervention, transfusion requirements, length of stay, thrombosis, and TXA dose administered. Results: There were 48 patients aged ≤16 years identified for inclusion using a massive transfusion protocol order. Twenty-nine (60%) patients received TXA. Baseline characteristics and results are presented as median (interquartile range) unless otherwise specified, with statistical significance defined as P < .05. Patients receiving TXA were more likely to be older, but there was no difference in injury type or Injury Severity Score at baseline. There was no difference in survival to discharge or thrombosis. Patients who did not receive TXA had numerically more frequent surgical intervention and longer length of stay, but these did not reach significance. Conclusions: TXA was utilized in 60% of pediatric trauma admissions at a single level 1 trauma center, more commonly in older patients. Although limited by observational design, we found patients receiving TXA had no difference in mortality or thrombosis.

Prehospital Tranexamic Acid in Major Pediatric Trauma Within a Physician-Led Emergency Medical Services System: A Multicenter Retrospective Study

“…During the study period, a total of 1,016 children experienced a major trauma and were screened for inclusion; after exclusion of cases where no MMT The median ISS was significantly higher in the TXA group (14 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] vs 6 [2][3][4][5][6][7][8][9][10][11][12][13]; p < 0.001), and severe injuries (AIS ≥ 3) were more frequent in the TXA group in all body regions (limbs/hip 40.1% vs 13.1%; thorax 30.4% vs 17.5%; head 25.7% vs 14.9%; abdomen 16% vs 6.4%; p < 0.001). Overall mortality was 3.1% (n = 25).…”

“…Among patients with no criteria for appropriate TXA use, 19.5% yet received a loading dose (Table 3). Within the group of patients presenting with appropriate TXA use criteria, those who did not receive TXA were younger (13 [8-16] vs 16 yr [13-17 yr]; p < 0.001) and had a lower ISS (14 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] vs 17 [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]; p < 0.001) compared with those who did. There was no significant difference in terms of sex (p = 0.12), type of trauma (p = 0.39), or trauma mechanism (p = 0.08).…”

Pediatric Traumatic Hemorrhagic Shock Consensus Conference Recommendations

“…The second retrospective study evaluated massively transfused injured children and compared patients who received TXA with those who did not. 59 They found no mortality difference between groups, but this study had a small sample size (n = 48).…”

Developing a National Trauma Research Action Plan: Results from the Pediatric Research Gap Delphi Survey

“…Thus far, TXA administration has shown a possible survival benefit in pediatric combat trauma victims 31 but no difference in mortality or thrombosis in a civilian pediatric trauma population. 32 Finally, there were a number of questions on rehabilitation and phases of care that were rated high priority. A question about a scale for predicting long-term outcome in TBI received the fourth highest overall ranking.…”