The impact of blood product ratios in massively transfused pediatric trauma patients

Health care professionals must understand the impact of blood product transfusions and transfusion therapy procedures to ensure high-quality patient care, positive outcomes, and wise use of resources in blood management programs. Understanding transfusions of blood and blood products is also important because of the number of treatments performed, which affects individual patients and health care system resources. This article reviews research findings to acquaint health care professionals with the most successful protocols for blood, blood product, and coagulation factor transfusions. Damage control resuscitation in bleeding trauma patients, protocols for patients without trauma who are undergoing surgical procedures that place them at risk for excessive bleeding, and protocols for patients with sepsis are addressed. Emerging research continues to help guide mass transfusion treatments (restrictive vs liberal, balanced, and goal-directed treatment). Although available study results provide some guidance, questions remain. Additional research by health care professionals is needed.

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Prospective evaluation of admission cortisol in trauma

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2019-000386 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000386

Author(s):

Amy M Kwok ◽

James W Davis ◽

Rachel C Dirks ◽

Lawrence P Sue ◽

Mary M Wolfe ◽

...

Keyword(s):

Mortality Rate ◽

Cortisol Level ◽

Blood Product ◽

Total Serum ◽

Trauma Patients ◽

Blood Draw ◽

Cortisol Levels ◽

Low Cortisol ◽

Vasopressor Use ◽

The Impact

BackgroundA low cortisol level has been shown to occur soon after trauma, and is associated with increased mortality. The purpose of this study was to investigate the impact of low cortisol levels in acute critically ill trauma patients. We hypothesized that patients would require increase vasopressor use, have a greater blood product administration, and increased mortality rate.MethodsA blinded, prospective observational study was performed at an American College of Surgeons verified Level I trauma center. Adult patients who met trauma activation criteria, received initial treatment at Community Regional Medical Center and were admitted to the intensive care unit were included. Total serum cortisol levels were measured from the initial blood draw in the emergency department. Patients were categorized according to cortisol ≤15 µg/dL (severe low cortisol, SLC), 15.01–25 µg/dL (relative low cortisol, RLC), or >25 µg/dL (normal cortisol, NC) and compared on demographics, injury severity score, initial vital signs, blood product usage, vasopressor requirements, and mortality.ResultsCortisol levels were ordered for 280 patients; 91 were excluded and 189 were included. Penetrating trauma accounted for 19% of injuries and blunt trauma for 81%. 22 patients (12%) had SLC, 83 (44%) had RLC, and 84 (44%) had NC. This study found patients with admission SLC had higher rates of vasopressor requirements, required more units of blood, and had a higher mortality rate than both the RLC and NC groups.ConclusionLow cortisol level can be identified acutely after severe trauma. Trauma patients with SLC had larger blood product requirements, vasopressor use, and increase mortality. Initial cortisol levels are useful in identifying these high-risk patients.Level of evidencePrognostic/epidemiologic study, level III

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QS355. Blood Product Transfusions in Pediatric Trauma Patients are not Associated with an Increase in Morbidity and Mortality

Journal of Surgical Research ◽

10.1016/j.jss.2007.12.608 ◽

2008 ◽

Vol 144 (2) ◽

pp. 408

Author(s):

Cynthia Leaphart ◽

Megan Sippey ◽

Kathy Gismondi ◽

Barbara A. Gaines

Keyword(s):

Blood Product ◽

Pediatric Trauma ◽

Morbidity And Mortality ◽

Trauma Patients

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The impact of acute coagulopathy on mortality in pediatric trauma patients

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000001060 ◽

2016 ◽

Vol 81 (2) ◽

pp. 312-318 ◽

Cited By ~ 6

Author(s):

Aaron Strumwasser ◽

Allison L. Speer ◽

Kenji Inaba ◽

Bernardino C. Branco ◽

Jeffrey S. Upperman ◽

...

Keyword(s):

Pediatric Trauma ◽

Trauma Patients ◽

The Impact

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Ventilator Associated Pneumonia in Pediatric Trauma Patients

Proceedings of IMPRS ◽

10.18060/25738 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Dalton Sullivan ◽

Matthew P. Landman ◽

Rachel E. Gahagen Gahagen

Keyword(s):

Risk Factors ◽

Pediatric Trauma ◽

Trauma Patients ◽

Ventilator Associated Pneumonia ◽

Hospital Acquired Infection ◽

Trauma Population ◽

Hospital Acquired ◽

Cultured Bacteria ◽

The Impact ◽

Overall Mortality

Background: Ventilator associated pneumonia (VAP) is a common hospital-acquired infection found in intubated trauma patients. In previous adult studies, VAP has been associated with an increase in length of stay, cost, morbidity, mortality, and longer mechanical ventilation. There remains little examination of the risk factors, prognosis, and microbiology of VAP within the pediatric trauma population. This study aims to analyze factors associated with VAP in pediatric trauma patients. Methods: The Riley Hospital for Children Trauma Registry was utilized to identify intubated pediatric trauma patients from 2016-2020. Patients were excluded if intubated for less than 48 hours. VAP was defined as positive if patients met either Centers for Disease Control definition and or were clinically diagnosed with and treated for VAP. Univariate and multivariate modeling was performed. Results: A total of 171 patients met inclusion criteria and 43 (25%) were diagnosed with VAP. The median age was 8 years (2-13) and ISS was 26.5 (22-35). The median duration of intubation was 203.8 hours (117.3-331.3). The overall mortality was 55 (32.2%). While variables such as lower age and use of MTP resulted in a higher likelihood of mortality, VAP diagnosis was not associated with increased mortality. BAL analysis displayed that the most common cultured bacteria were H. influenzae, Staph. aureus, and Strep. Pneumoniae with most VAPs being diagnosed on day 2 of admission. When analyzing the impact of age, ISS, intubation hours, ICU days, and GI prophylaxis on VAP, only age was significantly associated with VAP: for each year the odds of VAP rose by 10%. Conclusions: A quarter of the pediatric trauma patients were diagnosed with VAP during the study period. No modifiable risk factors were found for VAP with only patient age demonstrating significance for the diagnosis. Further investigation into VAP definition and prevention in pediatric trauma patients should occur given it’s prevalence.

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The impact of managing moderately injured pediatric trauma patients without immediate surgeon presence

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2007.01.037 ◽

2007 ◽

Vol 42 (6) ◽

pp. 1026-1030 ◽

Cited By ~ 6

Author(s):

Jonathan I. Groner ◽

Julia Covert ◽

Wendi L. Lowell ◽

John R. Hayes ◽

Benedict C. Nwomeh ◽

...

Keyword(s):

Pediatric Trauma ◽

Trauma Patients ◽

The Impact

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Use of Payer as a Proxy for Health Insurance Status on Admission Results in Misclassification of Insurance Status among Pediatric Trauma Patients

The American Surgeon ◽

10.1177/000313481608200218 ◽

2016 ◽

Vol 82 (2) ◽

pp. 146-151 ◽

Cited By ~ 2

Author(s):

Elizabeth A. Carter ◽

Lauren J. Waterhouse ◽

Roy Xiao ◽

Randall S. Burd

Keyword(s):

Emergency Department ◽

Health Insurance ◽

Confidence Interval ◽

Trauma Registry ◽

Pediatric Trauma ◽

Insurance Status ◽

Trauma Patients ◽

Patient Medical Record ◽

Health Insurance Status ◽

The Impact

The purpose of this study was to quantify health insurance misclassification among children treated at a pediatric trauma center and to determine factors associated with misclassification. Demographic, medical, and financial information were collected for patients at our institution between 2008 and 2010. Two health insurance variables were created: true (insurance on hospital admission) and payer (source of payment). Multivariable logistic regression was used to determine which factors were independently associated with health insurance misclassification. The two values of health insurance status were abstracted from the hospital financial database, the trauma registry, and the patient medical record. Among 3630 patients, 123 (3.4%) had incorrect health insurance designation. Misclassification was highest in patients who died: 13.9 per cent among all deaths and 30.8 per cent among emergency department deaths. The adjusted odds of misclassification were 6.7 (95% confidence interval: 1.7, 26.6) among patients who died and 16.1 (95% confidence interval: 3.2, 80.77) among patients who died in the emergency department. Using payer as a proxy for health insurance results in misclassification. Approaches are needed to accurately ascertain true health insurance status when studying the impact of insurance on treatment outcomes.

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