While we were not able to show improvements in outcome, MTP implementation led to higher plasma and PLT:RBC ratios without an associated change in blood product use or composite morbidity.

Objective: High ratio of plasma to red blood cells during massive transfusion is associated with improved survival of traumatic injuries in adults, but this has not been demonstrated in children. Our objective was to compare the outcome of children who received high (!1:2) versus low (<1:2) plasma: red blood cells (P:R) ratios at 24 h from injury. Methods: We conducted a retrospective chart review of children <18 years of age who presented to the emergency department over a 7-year period and received massive transfusion (!40 ml/kg red blood cells or !80 ml/kg total blood products in 24 h). Our primary outcome of interest was in-hospital mortality. Results: We identified 38 children who received massive transfusion. There was no significant difference in in-hospital mortality (45.8% vs. 64.3%) between the high (n ¼ 24, median ratio 1:1.1) and low P:R ratio (n ¼ 14, median 1:3.2) groups. In subset analyses, there was reduced mortality for high P:R patients with BIG score !24 (69.2% vs. 100%) and those taken to the operating room within 6 h of arrival (21.4% vs. 60.0%), respectively (p < 0.05). There was a trend for improved survival in high P:R patients without severe traumatic brain injury (TBI) (0% vs. 40.0%).Conclusions: This study suggests that high P:R transfusion may improve in-hospital survival of injured children at high risk of mortality and in children without severe TBI, supporting the need for large, multi-center studies.

Distortions of the experience of time are central to some types of dissociative experiences. In this study, we investigated the relationship between a self-report measure of temporal disintegration and symptoms of dissociation in depersonalization disorder (DPD). Fifty-two DPD and thirty non-clinical control participants were administered the Dissociative Experience Scale (DES) and Temporal Integration Inventory (TII). The DPD group had significantly higher TII scores than the control group. Within the DPD group, there was a significant positive correlation between DES total score and TII total score, and between TII-time distinction subscale score and TII-agency subscale score. In the DPD group, TII scores were not associated with age of onset or duration of illness. Of the three dissociative domains of absorption, amnesia, and depersonalization/derealization, only absorption was a significant predictor of TII total and subscale scores by stepwise linear regression analyses. We conclude that the experience of temporal disintegration in DPD is not directly related to the core symptoms of depersonalization/derealization, but exists when the depersonalized experience involves more prominent absorption.

Objective: Predictive scores were developed in adults to identify patients at risk for traumatic hemorrhage but have not been studied in children. Our objective was to identify clinical predictors of massive transfusion (!40 ml/kg red blood cells or !80 ml/kg total blood product at 24 h) in injured children. Methods: We conducted a retrospective case-control study of children <18 years old who presented from 2005 to 2014 for trauma care. Cases were children who received massive transfusion. Two control groups were identified: (1) 'random' and (2) matched for age and injury severity score (matched). Variables included vital signs, injury mechanism, active bleeding, and laboratory values. Multivariate logistic regression models to predict massive transfusion were developed using only clinical findings ('pre-arrival' model) and then also including laboratory values (emergency department model). Results: Of 11,995 injured children, 44 received massive transfusion. We selected 132 random and 127 matched controls. Using random controls, the pre-arrival model included heart rate, Glasgow Coma Scale, temperature, and penetrating injury mechanism (AUC ¼ 0.965). With matched controls, the pre-arrival model included Glasgow Coma Scale, penetrating injury, and active bleeding resulted (AUC ¼ 0.812). The ED model using random controls included Glasgow Coma Scale, hemoglobin, and penetrating injury (AUC ¼ 0.987). The emergency department model using matched controls included hemoglobin, temperature, prolonged partial thromboplastin time, and active bleeding on arrival (AUC ¼ 0.734). Conclusions: We identified predictive models for children who receive massive transfusion that rely on only clinical findings pre-arrival to the emergency department and then incorporate laboratory tests for those in the emergency department.