@article{ref1,
title="Defining massive transfusion in civilian pediatric trauma",
journal="Journal of pediatric surgery",
year="2019",
author="Rosenfeld, Eric H. and Lau, Patricio and Zhang, Wei and Russell, Robert T. and Shah, Sohail R. and Naik-Mathuria, Bindi and Vogel, Adam M.",
volume="54",
number="5",
pages="975-979",
abstract="PURPOSE: The purpose of this study was to identify an optimal definition of massive transfusion (MT) in civilian pediatric trauma. <br><br>METHODS: Severely injured children (age ≤18 years, injury severity score ≥25) in the Trauma Quality Improvement Program research datasets 2014-2015 that received blood products were identified. Children with traumatic brain injury and non-survivable injuries were excluded. Early mortality was defined as death within 24 h and delayed mortality as death after 24 h from hospital admission. Receiver operating curves and sensitivity and specificity analysis identified an MT threshold. Continuous variables are presented as median [IQR]. <br><br>RESULTS: Of the 270 included children, the overall mortality was 27% (N = 74). There were no differences in demographics or mechanism of injury between children that lived or died. Sensitivity and specificity for early mortality was optimized at a 4-h transfusion volume of 37 ml/kg. After controlling for other significant variables, a threshold of 37 ml/kg/4 h predicted the need for a hemorrhage control procedure (OR 8.60; 95% CI 4.25-17.42; p < 0.01) and early mortality (OR 4.24; 95% CI 1.96-9.16; p < 0.01). <br><br>CONCLUSION: An MTP threshold of 37 mL/kg/4 h of transfused blood products predicted the need for hemorrhage control procedures and early mortality. This threshold may provide clinicians with a timely prognostic indicator, improve research methodology, and resource utilization. TYPE OF STUDY: Diagnostic Test. LEVEL OF EVIDENCE: III.<br><br>Copyright © 2019 Elsevier Inc. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0022-3468",
doi="10.1016/j.jpedsurg.2019.01.029",
url="http://dx.doi.org/10.1016/j.jpedsurg.2019.01.029"
}