Whole blood resuscitation in pediatric trauma: A national analysis of use and associated outcomes.

PURPOSE: Hemorrhagic shock and need for blood transfusion are predictors of mortality in pediatric trauma. Limited data exists regarding the utilization of whole blood (WB) for pediatric trauma. This study aimed to evaluate trends in use of WB in pediatric trauma and assess its impact on outcomes.

METHODS

We performed a retrospective cohort study of the Trauma Quality Improvement Program (TQIP) database from 2017 to 2022. Patients ≤18 years who received a blood transfusion within 24 hours of hospital arrival were stratified into those receiving any WB and those receiving only component therapy (CT). The primary outcome was utilization of WB in children. Multivariate regression was used to predict secondary outcome measures.

RESULTS

We identified 20,338 patients: 1780 received WB and 18,558 received CT. From 2017 to 2022, there was a 14.2 % increase, 12.9 % increase, and 1.3 % decrease in patients receiving WB at adult, mixed adult-pediatric, and pediatric facilities, respectively. WB had increased amount of blood transfused as compared to CT. Adjusting for age, sex, weight, injury mechanism, injury severity score, total units of blood products transfused, hemorrhage control interventions and hospital setting, the WB cohort was more likely to have shorter hospital LOS except among patients with TBI.

CONCLUSION

During the study period, the use of WB for pediatric trauma resuscitation increased at adult trauma and mixed trauma centers but has remained stagnant at pediatric trauma centers. Use of WB was not associated with decreased transfusions or improved mortality. Further randomized controlled trials are needed to understand the true benefit of whole blood use in this population.

LEVEL OF EVIDENCE: III.