(1580) An Analysis of Pediatric Whole Blood Use in the National Trauma Registry

Introduction: Hemorrhage is a leading cause of death in pediatric trauma patients. The use of balanced component transfusion therapy has a demonstrated benefit most notably in the adult population. The use whole blood (WB) is safe in pediatric trauma patients. However, less is known about the overall current use and survival. We sought to assess the frequency of WB use in pediatric trauma patients and characterize patient factors associated with WB use.

Methods: We requested and analyzed data from patients < 15 years of age in the American College of Surgeons Trauma Quality Improvement Program (TQIP) database that received any blood within the first 4-hours comparing whole blood versus non-whole blood recipients. A massive transfusion was defined as ≥40mL/kg based on our previous work.

Results: From 2020-2021, there were 2942 that met inclusion for this analysis. Of those, 251 (9%) had documented receipt of whole blood. The number of whole blood recipients increased from 2020 to 2021 (7% versus 9%). Most were of the age 5-9 years of age and male for both groups. Median injury severity scores were similar between the groups. Collisions followed by firearms were the most frequent mechanisms in both groups. Survival at 24-hours and to hospital discharge was similar between the groups. A higher proportion of non-recipients received a massive transfusion (95% versus 56%). Component volumes administered between the two groups were not significantly different.

Conclusions: Within this nationwide analysis, we found that 9% of pediatric blood recipients were administered whole blood with an increase noted from 2020 to 2021. Survival did not differ between the non-recipients and recipients. Larger prospective studies are needed.