An analysis of the pediatric casualties undergoing massive transfusion in Iraq and Afghanistan

Schauer, Steven G; Wheeler, Abigail R.; April, Michael D.; Gale, Hannah L.; Becker, Tyson E.; Hill, Guyon J.; Borgman, Matthew A.

doi:10.1016/j.ajem.2019.07.007

Cited by 20 publications

(29 citation statements)

References 25 publications

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“…Pediatric casualties who required a blood transfusion were most commonly administered component blood therapy (96%) compared with WFWB (4%), which is consistent with our previous analysis 3, 5 . In this study, we found an independent association between the use of WFWB and survival in children without severe traumatic brain injury.…”

Section: Discussionsupporting

confidence: 90%

“…We also lack data on the time from injury to presentation, which has a major effect on outcome regardless of blood administration practices. Lastly, documentation in the deployed setting is often limited, which may lead to omissions in data, generally with documentation or data abstraction 5, 21 …”

Section: Discussionmentioning

confidence: 99%

“…4 In Afghanistan and Iraq, 15.7% of pediatric patients meet the criteria for a massive transfusion. 5 Starting in the year 2004, there was a resurgence in the use of warm fresh whole blood (WFWB) in the conflicts in Afghanistan and Iraq. This resurgence was multifactorial: "walking donors" enabled blood delivery to forward locations, platelet transfusions were unavailable given their short shelf life, and there was retrospective evidence of the benefit of whole blood over individual component therapy.…”

Section: Introductionmentioning

confidence: 99%

“…However, for patients with life-threatening hemorrhage when component therapy is not available, the riskbenefit ratio for WFWB favors its use. 12 Retrospective studies in adults indicate the use of WFWB is independently associated with improved survival, 13,14 but there are very little data for evaluating WFWB in children with severe traumatic bleeding. The goal of our study was to examine the association between the use of WFWB and survival in children with severe traumatic injury.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, Neff et al demonstrated 31% ( n = 1113) of pediatric patients received blood products within 24 h of arrival to combat hospitals 4 . In Afghanistan and Iraq, 15.7% of pediatric patients meet the criteria for a massive transfusion 5 …”

Section: Introductionmentioning

confidence: 99%

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An analysis of outcomes for pediatric trauma warm fresh whole blood recipients in Iraq and Afghanistan

et al. 2021

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Background Whole blood therapy—which contains the ideal balance of components, and particularly fresh whole blood—has been shown to be beneficial in adult trauma. It remains unclear whether there is potential benefit in the pediatric population. Study Design and Methods This is a secondary analysis of previously published data analyzing pediatric casualties undergoing massive transfusion in the Department of Defense Trauma Registry. Pediatric patients with traumatic injury who were transfused at least one blood product were included in the analysis. We compared children who received component therapy exclusively to those who received any amount of warm fresh whole blood. Results Of the 3439 pediatric casualties within our dataset, 1244 were transfused at least one blood product within the first 24 h. There were 848 patients without severe head injury. Within this cohort, 23 children received warm fresh whole blood overall, 20 of whom did not have severe head injury. In an adjusted analysis, the odds ratio (95% confidence interval [CI]) for survival for warm fresh whole blood recipients was 2.86 (0.40–20.45). After removing children with severe brain injury, there was an independent association with improved survival for warm fresh whole blood recipients with an odds ratio (95% CI) of 58.63 (2.70–1272.67). Discussion Our data suggest that warm fresh whole blood may be associated with improved survival in children without severe head injury. Larger prospective studies are needed to assess the efficacy and safety of whole blood in children with severe traumatic bleeding.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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An analysis of outcomes for pediatric trauma warm fresh whole blood recipients in Iraq and Afghanistan

et al. 2021

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Pediatric Infectious Diseases Encountered During Wartime Part II: Infectious Diseases Complications in the Individual Pediatric Patient

Cirks

Rajnik

Madden

et al. 2021

Curr Infect Dis Rep

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Purpose of Review Children in many regions face the daily threat of injury from armed conflict. The direct effects of combat trauma have led to many morbidities in survivors, including a variety of infectious complications. Contemporary experiences from recent military operations have advanced combat casualty care and concurrently informed the care of civilian combat trauma. Unfortunately, there is a lack of data to correlate the impact armed conflict has on the specific risks for infection in pediatric casualties. We review modern literature and apply data from adult casualties to pediatric combat trauma features to form management considerations and identify future research needs. Children require a disproportionately high number of resources when injured, and recently developed pediatric injury severity scoring systems can be predictive of potential outcomes. Blast injuries are the most common trauma type, and children suffer unique injury patterns with subsequent risks for infections. Experience has shown that mixed injuries, including blasts, penetrating injuries, burns, and the need for massive blood transfusions, can pose unique infectious challenges such as invasive fungal infections. Antimicrobial resistance is a top health priority with combat injuries, as multidrug-resistant organisms rapidly emerge in hospitals caring for those injured in conflict. Resources to assist in the management of infectious complications of direct injury to children in armed conflict regions are provided. Recent FindingsWe review the recent literature with an emphasis on publications over the past decade, apply data from adult casualties to pediatric combat trauma features to form management considerations, and identify future research needs. Summary Children require a disproportionately high number of resources when injured, and recently developed pediatric injury severity scoring systems can be predictive of potential outcomes. Blast injuries are the most common trauma type, and children suffer unique injury patterns with subsequent risks for infections. Experience has shown that mixed injuries, including blasts, penetrating injuries, burns, and the need for massive blood transfusions, can pose unique infectious challenges such as invasive fungal infections. Antimicrobial resistance is a top health priority with combat injuries, as multidrugresistant organisms rapidly emerge in hospitals caring for those injured in conflict. Resources are provided to assist in the management of infectious complications resulting from direct injury to children in armed conflict regions.

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Massive Transfusion Protocols in Pediatric Trauma

Furman,

Spinella,

Leeper

et al. 2024

Curr Trauma Rep

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An analysis of the pediatric casualties undergoing massive transfusion in Iraq and Afghanistan

Cited by 20 publications

References 25 publications

An analysis of outcomes for pediatric trauma warm fresh whole blood recipients in Iraq and Afghanistan

An analysis of outcomes for pediatric trauma warm fresh whole blood recipients in Iraq and Afghanistan

Pediatric Infectious Diseases Encountered During Wartime Part II: Infectious Diseases Complications in the Individual Pediatric Patient

Massive Transfusion Protocols in Pediatric Trauma

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