(1578) Scoring System for Early Activation of Massive Transfusion Protocols in Pediatric Trauma Patients

Introduction: Massive transfusion protocols (MTPs) are vital for managing traumatic hemorrhage. The optimal strategies to initiate MTPs should balance the immediate availability of blood products with the waste of unused products. Existing adult scoring systems fail to identify pediatric patients requiring massive transfusions. This study aimed to develop a practical scoring system to initiate MTPs in pediatric trauma patients.

Methods: This is a retrospective cohort study using the National Trauma Data Bank (NTDB) data from 2018. Pediatric patients aged 1 to 15 years were included, and factors associated with receiving more than 40 mL/kg of blood products within 4 and 24 hours were identified.

Results: Six hundred and sixty subjects were included in the score development dataset: median age was 9 years (IQR 4;13), median weight was 34 kg (IQR 18;55), and median Abbreviated Injury Score (AIS) was 5. Subjects received a median of 27 mL/kg of blood products (IQR 13;51) during the first 4 hours; 222 subjects received more than 40 mL/kg of blood products. The overall mortality rate was 33%. The scoring system identified four independent factors associated with massive transfusion within 4 hours: 1 point for age ≤ 4 years; 1 for penetrating trauma; 1 for initial temperature of 36.4°C to 36.7°C, 2 for temperature of 35.7°C to 36.3°C, and 3 for temperature below 35.7°C; and 2 points for needing surgery for hemorrhagic control. The area under the receiver-operating characteristic curve was 0.72, indicating accurate prediction of the need for massive transfusion.

Conclusions: The proposed scoring system was accurate in identifying pediatric trauma patients who will require massive transfusions. By rapidly assessing the need for massive transfusion without relying on lab values, the system may improve patient outcomes and reduce blood product waste. Prospective studies are needed to further validate the scoring system.