Massive transfusion in pediatric trauma-does more blood predict mortality?

Reppucci, Marina L.; Pickett, Kaci; Stevens, John; Phillips, Ryan; Recicar, John; Annen, Kyle; Moulton, Steven L.

doi:10.1016/j.jpedsurg.2021.09.051

Cited by 11 publications

(18 citation statements)

References 17 publications

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“…Other previous studies did not find that MBT influenced mortality. [6,7] The factors associated with MBT comprised age group, TBI, craniectomy operation, pre-operative hematocrit, and pre-operative INR following multivariable analysis. Older patients had a higher risk for MBT than younger patients.…”

Section: Discussionmentioning

confidence: 99%

“…[6] In addition, Reppucci et al reported that MBT did not impact mortality in massively transfused pediatric trauma patients. [7] Neurosurgical operations usually involve the critical anatomy, meaning there is risk of injury to major vascular structures and unexpected intraoperative bleeding. [8,9] However, there is a lack of evidence mentioned concerning the factors influencing MBT in neurosurgical operation from the literature review.…”

Section: Introductionmentioning

confidence: 99%

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Development and internal validation of a nomogram to predict massive blood transfusions in neurosurgical operations

Sungkaro

Taweesomboonyat

Kaewborisutsakul

2022

JNRP

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Objectives: A massive blood transfusion (MBT) is an unexpected event that may impact mortality. Neurosurgical operations are a major operation involving the vital structures and risk to bleeding. The aims of the present research were (1) to develop a nomogram to predict MBT and (2) to estimate the association between MBT and mortality in neurosurgical operations. Material and Method: We conducted a retrospective cohort study including 3660 patients who had undergone neurosurgical operations. Univariate and multivariate logistic regression analyses were used to test the association between clinical factors, pre-operative hematological laboratories, and MBT. A nomogram was developed based on the independent predictors. Results: The predictive model comprised five predictors as follows: Age group, traumatic brain injury, craniectomy operation, pre-operative hematocrit, and pre-operative international normalized ratio and the good calibration were observed in the predictive model. The concordance statistic index was 0.703. Therefore, the optimism-corrected c-index values of cross-validation and bootstrapping were 0.703 and 0.703, respectively. Conclusion: MBT is an unexpectedly fatal event that should be considered for appropriate preparation blood components. Further, this nomogram can be implemented for allocation in limited-resource situations in the future.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Development and internal validation of a nomogram to predict massive blood transfusions in neurosurgical operations

Sungkaro

Taweesomboonyat

Kaewborisutsakul

2022

JNRP

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“…About 50% of deaths from exsanguination occur within the 6 hours following injury, with most deaths occurring during the first hour. [1][2][3][4] Early recognition and intervention of hemorrhagic shock is associated with decreased 24-hour and 30-day mortality in adults. 5,6 Every minute delay in the time to blood cooler arrival, among adult trauma patients requiring massive blood transfusion, increases the odds of mortality by 5%.…”

Section: Introductionmentioning

confidence: 99%

Reducing the Time to Blood Administration after Pediatric Injury: A Quality Improvement Initiative

Sullivan

Milestone

Alberto

et al. 2022

Pediatric Quality &Amp; Safety

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Introduction: Hemorrhage is the leading cause of preventable death in pediatric trauma patients. Timely blood administration is associated with improved outcomes in children and adults. This study aimed to identify delays to transfusion and improve the time to blood administration among injured children. Methods: A multidisciplinary team identified three activities associated with blood transfusion delays during the acute resuscitation of injured children. To address delays related to these activities, we relocated the storage of un-crossmatched blood to the emergency department (ED), created and disseminated an intravenous access algorithm, and established a nursing educator role for resuscitations. We performed comparative and regression analyses to identify the impact of these factors on the timeliness and likelihood of blood administration. Results: From January 2017 to June 2021, we treated 2159 injured children and adolescents in the resuscitation area, 54 (2.5%) of whom received blood products in the ED. After placing a blood storage refrigerator in the ED, we observed a centerline change that lowered the adjusted time-to-blood administration to 17 minutes (SD 11), reducing the time-to-blood administration by 11 minutes (β = −11.0, 95% CI = −22.0 to −0.9). The likelihood of blood administration was not changed after placement of the blood refrigerator. We observed no reduction in time following the implementation of the intravenous access algorithm or a nursing educator. Conclusions: Relocation of un-crossmatched blood storage to the ED decreased the time to blood transfusion. This system-based intervention should be considered a strategy for reducing delays in transfusion in time-critical settings.

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“…H emorrhage accounts for nearly 20% of deaths after pediatric injury, with about half of hemorrhage-related deaths being preventable by more timely treatment. [1][2][3][4] Because 40% of deaths related to traumatic hemorrhage occur within 1 hour after patient arrival, rapid recognition and treatment during the resuscitation phase can decrease mortality and in-hospital morbidity. 1,[3][4][5][6][7][8] Strategies for improving hemorrhage-associated outcomes have primarily focused on components of resuscitation (e.g., balanced component resuscitation and systemic coagulation adjuncts) and physical hemorrhage control.…”

mentioning

confidence: 99%

“…[1][2][3][4] Because 40% of deaths related to traumatic hemorrhage occur within 1 hour after patient arrival, rapid recognition and treatment during the resuscitation phase can decrease mortality and in-hospital morbidity. 1,[3][4][5][6][7][8] Strategies for improving hemorrhage-associated outcomes have primarily focused on components of resuscitation (e.g., balanced component resuscitation and systemic coagulation adjuncts) and physical hemorrhage control. 9,10 Although potentially improving hemorrhage-associated outcomes, these interventions are less effective if delayed or not implemented during hemorrhagic shock.…”

mentioning

confidence: 99%

Time is Tissue: Barriers to Timely Transfusion after Pediatric Injury

Sullivan

Gestrich-Thompson

Milestone

et al. 2022

J Trauma Acute Care Surg

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Strategies to improve outcomes among children and adolescents in hemorrhagic shock have primarily focused on component resuscitation, pharmaceutical coagulation adjuncts, and hemorrhage control techniques. Many of these strategies have been associated with better outcomes in children, but the barriers to their use and the impact of timely use on morbidity and mortality have received little attention. Because transfusion is uncommon in injured children, few studies have identified and described barriers to the processes of using these interventions in bleeding patients, processes that move from the decision to transfuse, to obtaining the necessary blood products and adjuncts, and to delivering them to the patient. In this review, we identify and describe the steps needed to ensure timely blood transfusion and propose practices to minimize barriers in this process. Given the potential impact of time on hemorrhage associated outcomes, ensuring timely intervention may have a similar or greater impact than the interventions themselves.

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Massive transfusion in pediatric trauma-does more blood predict mortality?

Cited by 11 publications

References 17 publications

Development and internal validation of a nomogram to predict massive blood transfusions in neurosurgical operations

Development and internal validation of a nomogram to predict massive blood transfusions in neurosurgical operations

Reducing the Time to Blood Administration after Pediatric Injury: A Quality Improvement Initiative

Time is Tissue: Barriers to Timely Transfusion after Pediatric Injury

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