Prehospital shock index and systolic blood pressure are highly specific for pediatric massive transfusion

Background While massive transfusion protocols (MTP) are associated with decreased mortality in adult trauma patients, there is limited research on the impact of MTP on pediatric trauma patients. The purpose of this study was to compare pediatric trauma patients requiring massive transfusion to all other pediatric trauma patients to identify triggers for MTP activation in injured children. Methods Using our level I trauma center's registry, we retrospectively identified all pediatric trauma patients from January 2015 to January 2018. Massive transfusion (MT) was defined as infusion of 40 mL/kg of blood products in the first 24 hours of admission. Patients missing prehospital vital sign data were excluded from the study. We retrospectively collected data including: demographics, blood utilization, variable outcome data, prehospital vital signs, prehospital transport times, and injury severity scores (ISS). Statistical significance was determined using Mann-Whitney U test and chi-square test. P values less than 0.05 were considered significant. Results Thirty-nine of the 2,035 pediatric patients (1.9%) met criteria for MT. All-cause mortality in MT patients was 49% (19/39) versus 0.01% (20/1996) in Non-MT patients. The two groups significantly differed in ISS, prehospital vital signs, and outcome data.Both systolic blood pressure (SBP) 1.4 were found to be highly specific for massive transfusion with specificities of 86% and 92%, respectively. The combination of SBP 1.4 had a specificity of 94%. The positive and negative predictive values of SBP 1.4 in predicting massive transfusion were 18% and 98%, respectively. Based on positive likelihood ratios, patients with both SBP 1.4 were 7.2 times more likely to require massive transfusion than patients who did not meet both of these vital sign criteria. Conclusions Pediatric trauma patients requiring early blood transfusion present with lower blood pressures and higher heart rates, as well as higher shock indexes and lower pulse pressures. We found that shock index and systolic blood pressure are highly specific tools with promising likelihood ratios that could be used to identify patients requiring early transfusion. Levels of evidence and study type Therapeutic/Care Management, Level V.