Analysis of Prehospital Administration of Blood Products to Pediatric Casualties in Iraq and Afghanistan

Lauby, Ryann S; Johnson, Sarah A.; Borgman, Matthew A.; Bynum, James A.; Hill, Guyon J.; Schauer, Steven G

doi:10.1080/10903127.2020.1817216

Cited by 8 publications

(7 citation statements)

References 23 publications

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“…In their analysis of prehospital interventions in 3,439 children, Schauer et al 5 described intravenous fluid administration as one of the most frequent interventions, affecting 13.3% of studied patients. They found that 0.5% of children received prehospital blood products – a similar figure was reported by Lauby et al 38 likely reporting the same group of patients. Possible reasons for reported low levels of prehospital transfusion included inadequate availability of forward blood products, an absence of paediatric specific prehospital blood administration guidelines (if guidelines are available they are based on adult transfusion protocols) 38 and a lack of confidence among staff in their ability to administer prehospital blood products.…”

Section: Discussionsupporting

confidence: 75%

“…Titles and abstracts were screened leaving 145 records. Exclusion criteria were then applied to the remaining papers by reading the full text to identify 18 articles 3,5,12,16,[31][32][33][34][35][36][37][38][39][40][41][42][43][44] to be used in the review. This process is described in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart below (Figure 3).…”

Section: Resultsmentioning

confidence: 99%

“…Half of blast injury in children admitted to Camp Bastion was caused by IEDs and 12% by UXO. 47 Several studies in the review identified males as the predominant casualties receiving in-hospital 34 and prehospital 38 blood products and whole blood. 16 More males were injured in the conflicts but Gale et al 35 showed that females had a lower survival rate (OR 0.70, 95% CI 0.54-0.90) in their analysis of 3,439 children over 9 years.…”

Section: Demographics Of Paediatric Trauma Patientsmentioning

confidence: 99%

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A narrative review of damage control resuscitation for paediatric trauma patients in Iraq and Afghanistan from 2001 to 2016

Wright

Ramage

Barratt

et al. 2023

Trauma

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Introduction Requirement for blood transfusion in the injured paediatric civilian population is rare. Therefore, a substantial evidence base underpinning damage control resuscitation (DCR) in paediatric patients is lacking. Published outcome data originating from Iraq and Afghanistan offer a unique opportunity to study large cohorts of children who received DCR. It is hoped that by collating the data, this review will inform pre-deployment medical training and support the development of paediatric specific DCR guidelines, which can be used in all trauma environments. Methodology A comprehensive search of the literature was conducted using online databases, grey literature searching and screening of reference lists. Papers discussing blood product, crystalloid or tranexamic acid (TXA) administration in paediatric patients injured in Iraq and Afghanistan from 2001to present were included. Results Eighteen papers were included – all were retrospective studies of data from military trauma databases. Most children that received massive transfusion were male (73.4%), injured in Afghanistan (69.9%) by explosives (60.4%) with a median age of 9 years. A definition of paediatric massive transfusion of 40 ml/kg of all blood products within 24 h was developed. Massive transfusion rates were high (15.7% of children). Whole blood administration occurred in 4% of patients requiring blood transfusions. Low crystalloid volumes in combination with balanced blood product ratios were associated with improved survival, along with the use of whole blood and TXA. Conclusion The review offers insight into the paediatric population likely to require DCR and the optimal DCR strategies to be used in their management.

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Section: Discussionsupporting

confidence: 75%

Section: Resultsmentioning

confidence: 99%

Section: Demographics Of Paediatric Trauma Patientsmentioning

confidence: 99%

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A narrative review of damage control resuscitation for paediatric trauma patients in Iraq and Afghanistan from 2001 to 2016

Wright

Ramage

Barratt

et al. 2023

Trauma

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“…PRBC was the most frequently administered blood product for children registered in the DODTR between 2007 and 2016. For those arriving to the ED, Lauby et al 29 found that 33.8% were given PRBC prior to admission 20 . Warm fresh whole blood in children without severe brain injury was found to have an independent association with increased survival 30 .…”

Section: Discussionmentioning

confidence: 99%

A scoping review of two decades of pediatric humanitarian care during wartime

Kocik

Borgman

April

et al. 2023

J Trauma Acute Care Surg

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Humanitarian care is a vital component of the wartime mission. Children comprise a significant proportion of casualties injured by explosives and penetrating weapons. Children face a variety of unique injury patterns in the combat setting as high-powered firearms and explosives are rarely seen in the civilian setting. We sought to perform a scoping review of pediatric research from the recent US-led wars in Afghanistan, and Iraq conflicts beginning in 2001. We used Google Scholar and PubMed to identify pediatric combat literature published between 2001 and 2022. We utilized the PRISMA-ScR Checklist to conduct this review. We identified 52 studies that met inclusion for this analysis—1 prospective observational study, 50 retrospective studies, and 1 case report. All the original research studies were retrospective in nature except for one. We identified one prospective study that was a post hoc subanalysis from an overall study assessing the success of prehospital lifesaving interventions. Most of the articles came from varying registries created by the United States and British militaries for the purposes of trauma performance improvement. The deployed health service support mission often includes treatment of pediatric trauma patients. The deployed health service support mission often includes treatment of pediatric trauma patients. We found that available literature from this setting is limited to retrospective studies except for one prospective study. Our findings suggest that pediatric humanitarian care was a significant source of medical resource consumption within both of the major wars. Further, many of the lessons learned have directly translated into changes in civilian pediatric trauma care practices highlighting the need for collaborative scientific developments between the military and civilian trauma programs. LEVEL OF EVIDENCE Systematic Review/Meta-Analyses; Level III.

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“…Explosives were the predominant mechanism of injury among both groups. The composite injury severity score was 5 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11) in non-recipients and 16 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) in recipients. Among the blood recipients, there was a higher proportion of serious injuries to all body regions.…”

Section: All Casualtiesmentioning

confidence: 99%

Blood consumption in the Role 2 setting: A Department of Defense Trauma Registry analysis

McWhirter,

April,

Fisher

et al. 2024

Transfusion

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BackgroundThe Role 2 setting represents the most far‐forward military treatment facility with limited surgical and holding capabilities. There are limited data to guide recommendations on blood product utilization at the Role 2. We describe the consumption of blood products in this setting.Study Design and MethodsWe analyzed data from 2007 to 2023 from the Department of Defense Trauma Registry (DODTR) that received care at a Role 2. We used descriptive and inferential statistics to characterize the volumes of blood products consumed in this setting. We also performed a secondary analysis of US military, Coalition, and US contractor personnel.ResultsWithin our initial cohort analysis of 15,581 encounters, 17% (2636) received at least one unit of PRBCs or whole blood, of which 11% received a submassive transfusion, 4% received a massive transfusion, and 1% received a supermassive transfusion. There were 6402 encounters that met inclusion for our secondary analysis. With this group, 5% received a submassive transfusion, 2% received a massive transfusion, and 1% received a supermassive transfusion.ConclusionsWe described volumes of blood products consumed at the Role 2 during recent conflicts. The maximum number of units consumed among survivors exceeds currently recommended available blood supply. Our findings suggest that rapid resupply and cold‐stored chain demands may be higher than anticipated in future conflicts.

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Analysis of Prehospital Administration of Blood Products to Pediatric Casualties in Iraq and Afghanistan

Cited by 8 publications

References 23 publications

A narrative review of damage control resuscitation for paediatric trauma patients in Iraq and Afghanistan from 2001 to 2016

A narrative review of damage control resuscitation for paediatric trauma patients in Iraq and Afghanistan from 2001 to 2016

A scoping review of two decades of pediatric humanitarian care during wartime

Blood consumption in the Role 2 setting: A Department of Defense Trauma Registry analysis

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