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No transfusion reactions were reported. The median (IQR) time from ED admission to the start of the WB transfusion was 15 (14-77) minutes, compared with 303 (129-741) minutes (P < .001) for administration of at least 1 unit of RBCs, plasma, and platelets in the historical cohort (Figure).Discussion | To our knowledge, this is the first cohort of pediatric civilian trauma patients to receive WB during resuscitation. These preliminary data suggest that WB transfusion of up to 20 mL/kg is safe in children with severe injuries; there was no evidence of hemolysis in non-group O recipients, and no transfusion reactions were reported. Based on these data, the transfusion committee of Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center approved an increase in maximum volume of WB transfusion to 30 mL/kg. Larger cohorts are necessary for further study to determine if WB administration will affect outcomes, including number of donor exposures, cost, total volume transfused, and mortality.

The purpose of our study was to describe children with life-threatening bleeding. DESIGN:We conducted a prospective observational study of children with life-threatening bleeding events. SETTING: Twenty-four childrens hospitals in the United States, Canada, and Italy participated. SUBJECTS:Children 0-17 years old who received greater than 40 mL/kg total blood products over 6 hours or were transfused under massive transfusion protocol were included. INTERVENTIONS:Children were compared according bleeding etiology: trauma, operative, or medical. MEASUREMENTS AND MAIN RESULTS:Patient characteristics, therapies administered, and clinical outcomes were analyzed. Among 449 enrolled children, 55.0% were male, and the median age was 7.3 years. Bleeding etiology was 46.1% trauma, 34.1% operative, and 19.8% medical. Prior to the life-threatening bleeding event, most had age-adjusted hypotension (61.2%), and 25% were hypothermic. Children with medical bleeding had higher median Pediatric Risk of Mortality scores (18) compared with children with trauma (11) and operative bleeding (12). Median Glasgow Coma Scale scores were lower for children with trauma (3) compared with operative (14) or medical bleeding (10.5). Median time from bleeding onset to first transfusion was 8 minutes for RBCs, 34 minutes for plasma, and 42 minutes for platelets. Postevent acute respiratory distress syndrome (20.3%) and acute kidney injury (18.5%) were common. Twenty-eight-day mortality was 37.5% and higher among children with medical bleeding (65.2%) compared with trauma (36.1%) and operative (23.8%). There were 82 hemorrhage deaths; 65.8% occurred by 6 hours and 86.5% by 24 hours. CONCLUSIONS: Patient characteristics and outcomes among children with life-threatening bleeding varied by cause of bleeding. Mortality was high, and death from hemorrhage in this population occurred rapidly.

CSI in patients younger than 3 years is uncommon. Four simple clinical predictors can be used in conjunction to the physical examination to substantially reduce the use of radiographic imaging in this patient population.

Objective: To compare a propensity-matched cohort of injured children receiving conventional blood component transfusion to injured children receiving low-titer group O negative whole blood. Summary of Background Data: Transfusion of whole blood in pediatric trauma patients is feasible and safe. Effectiveness has not been evaluated. Methods: Injured children ≥1 years old can receive up to 40 mL/kg of cold-stored, uncrossmatched whole blood during initial hemostatic resuscitation. Whole blood recipients (2016–2019) were compared to a propensity-matched cohort who received at least 1 uncrossmatched red blood cell unit in the trauma bay (2013–2016). Cohorts were matched for age, hypotension, traumatic brain injury, injury mechanism, and need for emergent surgery. Outcomes included time to resolution of base deficit, product volumes transfused, and INR after resuscitation. Results: Twenty-eight children who received whole blood were matched to 28 children who received components. The whole blood group had faster time to resolution of base deficit [median (IQR) 2 (1–2.5) hours vs 6 (2–24) hours, respectively; P < 0.001]. The post-transfusion INR was decreased in whole blood vs component cohort [median (IQR) 1.4 (1.3–1.5) vs 1.6 (1.4–2.2); P = 0.01]. Lower plasma volumes [median (IQR) = 5 (0–15) mL/kg vs 11 (5–35) mL/kg; P = 0.04] and lower platelet volumes [median (IQR) = 0 (0–2) vs 3 (0–8); P = 0.03] were administered to the whole blood group versus component group. Other clinical variables (in-hospital death, hospital length of stay, intensive care unit length of stay, and ventilator days) did not differ between groups. Conclusions: Compared to component transfusion, whole blood transfusion results in faster resolution of shock, lower post-transfusion INR, and decreased component product transfusion. Larger cohorts are required to support these findings.

Background The Injury Severity Score (ISS) is the most commonly used injury scoring system in trauma research and benchmarking. An ISS>15 conventionally defines severe injury; however, no studies evaluate whether ISS performs similarly between adults and children. Our objective was to evaluate ISS and AIS to predict mortality and define optimal thresholds of severe injury in pediatric trauma. Methods Patients from the Pennsylvania trauma registry 2000–2013 were included. Children were defined as age<16years. Logistic regression predicted mortality from ISS for children and adults. The optimal ISS cut-off for mortality that maximized diagnostic characteristics was determined in children. Regression also evaluated association between mortality and maximum AIS in each body-region, controlling for age, mechanism, and non-accidental trauma. Analysis was performed in single and multisystem injuries. Sensitivity analyses with alternative outcomes were performed. Results There were 352,127 adults and 50,579 children included. Children had similar predicted mortality at ISS of 25 as adults at ISS of 15 (5%). The optimal ISS cut-off in children was ISS>25 and had a positive predictive value (PPV) of 19% and negative predictive value (NPV) of 99% compared to PPV of 7% and NPV of 99% for ISS>15 to predict mortality. In single-system injured children, mortality was associated with head (OR 4.80; 95%CI 2.61–8.84, p<0.01) and chest AIS (OR 3.55; 95%CI 1.81–6.97, p<0.01), but not abdomen, face, neck, spine, or extremity AIS (p>0.05). For multisystem injury, all body region AIS were associated with mortality except extremities. Sensitivity analysis demonstrated ISS>23 to predict need for full trauma activation, and ISS>26 to predict impaired functional independence were optimal. Conclusions ISS>25 may be a more appropriate definition of severe injury in children. Pattern of injury is important, as only head and chest injury drive mortality in single-system injured children. These findings should be considered in benchmarking and performance improvement efforts. Level of Evidence III, epidemiologic

Coated polyglactin 910 suture with triclosan performed as well or better than traditional coated polyglactin 910 suture in pediatric patients undergoing general surgical procedures. The incidence of postoperative pain was significantly less in patients treated with coated polyglactin 910 suture with triclosan than the traditional suture. We speculate that polyglactin 910 suture with triclosan, by inhibiting bacterial colonization of the suture, reduced pain that can be an indicator of "subclinical" infection. Coated polyglactin 910 suture with triclosan may be a useful alternative in patients at increased risk of developing SSI.

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