Background
Although controversial, early administration of tranexamic acid (TXA) has been shown to reduce mortality in adult patients with major trauma. Tranexamic acid has also been successfully used in elective pediatric surgery, with significant reduction in blood loss and transfusion requirements. There are limited data to guide its use in pediatric trauma patients. We sought to determine the current practices for TXA administration in pediatric trauma patients in the United States.
Methods
A survey was conducted of all the American College of Surgeons-verified Level I and II trauma centers in the United States. The survey data underwent quantitative analysis.
Results
Of the 363 Level I and II qualifying centers, we received responses from 220 for an overall response rate of 61%. Eighty of 99 verified pediatric trauma centers responded for a pediatric trauma center response rate of 81%. Of all responding centers, 148 (67%) reported they care for pediatric trauma patients, with an average of 513 pediatric trauma patients annually. The pediatric trauma centers report caring for an average of 650 pediatric trauma patients annually. Of all centers caring for pediatric trauma, 52 (35%) report using TXA, with the most common initial dosing being 15 mg/kg (68%). A follow-up infusion was utilized by 45 (87%) of the programs, most commonly dosed at 2 mg/kg/hr × 8 hr utilized by 24 centers (54%).
Conclusion
Although the clinical evidence for TXA in pediatric trauma patients is limited, we believe that consideration should be given for use in major trauma with hemodynamic instability or significant risk for ongoing hemorrhage. If available, resuscitation should be guided by thromboelastography to identify candidates who would most benefit from antithrombolytic administration. This represents a low-cost/low-risk and high-yield therapy for pediatric trauma patients.
The observed low rates of appropriate diagnostic coding of ANX, of epinephrine administration, epinephrine autoinjector prescribing at discharge, and referral for allergy evaluation call for more education on these issues. Some of these pitfalls can be partly attributed to the setting in a university ED where health providers are usually busy in rendering urgent care.
RATIONALE: The purpose of our study was to evaluate the diagnosis and management of patients who presented with anaphylaxis (ANX) at our university Emergency Department (ED) and to assess how the management correlated with the severity of the case and the training level of the ED staff. METHODS: This was a single-center, retrospective, descriptive study that involved reviewing the medical records of patients of any age who met established NIAID/FAAN criteria for ANX during a four-year period at our ED. RESULTS: By reviewing 1341 charts of potential cases, 60 met the criteria for ANX. Only 23% were correctly diagnosed with ANX. Inappropriate coding was noted in 77%, mainly as an ''allergic reaction.'' For treatment, whereas systemic corticosteroids were administered to 85% and H1-antihistamines to 73% of patients, only 20% received epinephrine. Of the latter, most of the prescribers were either senior-level residents or faculty members. Ten patients required hospital admission and 50 were discharged home. Among those discharged, prescriptions were given for oral corticosteroids in 64%, H 1 -antihistamines in 56%, and epinephrine auto-injector in 54%. Allergy evaluation referral was ordered for 8 (16%), but only 4 came for the visit. CONCLUSIONS: The observed high rate of miscoding ANX and low rates of epinephrine administration, of prescribing epinephrine autoinjectors, and of referral for allergy evaluation, call for more education on these issues in the ED.
Abstracts AB153
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