Consensus-based criteria for actionable hemorrhage in pediatric trauma: A Delphi study.
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Kim Mary S, Mun Aaron H, Arkowitz Dylan W, Sharf Tamara, Borgman Matthew, Chaudhari Pradip P, Chiusolo Fabrizio, Cotton Bryan A, Delaney Meghan, Ditillo Michael, Finkelstein Robert A, Gaines Barbara A, Hewes Hilary A, Holmes James F, Jenkins Donald H, Karam Oliver, Kornblith Aaron, Leeper Christine M, Muszynski Jennifer A, Nahmias Jeffry, Nishijima Daniel K, Notrica David M, Russell Robert T, Spinella Philip C, Steiner Marie E, Streck Christian J, Stricker Paul A, Vavilala Monica S, Vogel Adam M, Yazer Mark H, Kuppermann Nathan, Leonard Julie C, Jensen Aaron R, Burd Randall S
Аннотация
METHODS: Experts from six specialties involved in pediatric trauma care participated in a modified Delphi study. Panelists were prompted to consider "actionable hemorrhage" as "severe bleeding or injuries at risk of progression to class III or IV shock without prompt intervention." In Round 1, panelists answered five free-response questions identifying criteria for actionable hemorrhage, including indicators for transfusion and hemorrhage control procedures, postmortem findings, and other relevant factors. Responses were consolidated and rated on a five-point strength-of-indication scale in subsequent rounds. Consensus was defined a priori as ≥70% agreement among panelists. Stability of consensus ( p >0.05) between rounds was assessed using the Wilcoxon Signed-Rank Test.
RESULTS: Three Delphi rounds were required to achieve a stable consensus. Twenty-nine of 32 participating panelists participated in all three rounds. Thirteen statements achieved stable consensus as strong indicators of actionable hemorrhage. Criteria with the highest agreement included partial/total resection of intrathoracic/abdominal bleeding solid organs (96.4%), hemoglobin<6 g/dL (93.1%), and resuscitative thoracotomy/sternotomy with hilar or thoracic/abdominal aortic cross-clamp, cardiac massage, or cardiorrhaphy (92.9%). No statements reached a stable consensus as weak indicators of actionable hemorrhage.
CONCLUSIONS: We established expert consensus criteria for adjudication of actionable hemorrhage in injured children within 6 hours of ED arrival. These criteria reflect strong indicators that an intervention or death was due to an actionable hemorrhage. Prospective validation of these criteria is needed. ( J Trauma Acute Care Surg . 2026;101: 415-422. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved.).
LEVEL OF EVIDENCE: Diagnostic Test/Criteria; Level III.