The ABC-D score improves the sensitivity in predicting need for massive transfusion in pediatric trauma patients

Phillips, Ryan; Acker, Shannon N.; Shahi, Niti; Meier, Maxene; Leopold, David; Recicar, John; Kulungowski, Ann M.; Patrick, David; Moulton, Steven L.; Bensard, Denis D.

doi:10.1016/j.jpedsurg.2019.10.008

Cited by 32 publications

(49 citation statements)

References 16 publications

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Section: Discussionmentioning

confidence: 99%

“…Recently, our team developed the ABC-D score, to identify pediatric patients at risk for MT [2]. We showed that the addition of abnormal base deficit/lactate to the adult ABC score improved the sensitivity (> 90%) in identifying children who will need MT [2]. Considering the results from our previous work combined with ability to view TEG in realtime offers potential for the development of a more accurate tool to identify and guide the resuscitation of pediatric patients who undergo MT.…”

Section: Discussionmentioning

confidence: 99%

“…MT was defined as 40 cc/kg of total blood products within the first six hours of arrival to either PTC or its activation was at the discretion of the physician at the time of trauma based on predicted volume loss and other clinical parameters independent of TEG results. [2]. Secondary aims were to compare the total number of ventilator days, intensive care unit (ICU) length of stay (LOS), hospital LOS, and mortality.…”

Section: Data Collectionmentioning

confidence: 99%

“…Trauma accounts for one million pediatric deaths globally each year, with over eighty percent of all preventable deaths associated with hemorrhage [1]. Pediatric trauma patients who require massive transfusion (MT) have a mortality rate of over 40%, yet few studies aim to optimize care for these children [2,3]. Following publication of adult data, there has been a gradual shift led by pediatric trauma centers in the U.S., to restrict crystalloid administration and deliver early balanced blood product resuscitation for children with evidence of hemorrhagic shock [4].…”

Section: Introductionmentioning

confidence: 99%

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It is time for TEG in pediatric trauma: unveiling meaningful alterations in children who undergo massive transfusion

et al. 2021

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Background Hemorrhage is the leading cause of preventable death in pediatric trauma patients. In adults, goal-directed thrombelastography (TEG) has been shown to reduce mortality when used to guide massive transfusion (MT) resuscitation. There remains a paucity of data on the utility of TEG in directing resuscitation of pediatric trauma patients. We hypothesize that abnormalities on admission TEG will differ in pediatric trauma patients who undergo MT, compared to those who do not. Methods Pediatric patients (≤ 18 years) who were highest level trauma activations at two trauma centers from 2015 to 2018 were analyzed. We included patients who had admission TEGs and excluded those who did not. Patients were stratified into two groups: those who received MT (> 40 cc/kg total blood product within 6 h of admission) and those who did not. We defined TEG abnormalities based on each institution's normative values and compared TEG abnormalities between the groups. Results Of 117 children included, 39 had MT. MT patients had higher injury severity scores (30 vs. 23, p = 0.0004), lactates levels (7.0 vs. 3.5, p < 0.001), base deficit levels ( − 12.2 vs. − 5.8, p < 0.001), and INR values (1.8 vs. 1.3, p < 0.001). MT patients had significantly shortened alpha-angles (35.9% vs. 15.4%, p = 0.023), maximum amplitude (MA) values (43.6% vs. 10.3%, p < 0.001), and significantly lower platelet counts (165 vs. 281, p < 0.001) compared to those who did not receive MT. There was no difference in the trends in R-time, LY30 (lysis or shutdown), or fibrinogen concentration between the groups. Logistic regression identified a decreased MA as a significant predictor for MT )] Conclusions Pediatric trauma patients who undergo MT are more likely to have lower alpha-angles and MA values, as well as lower platelet counts. These findings support the use of TEG to identify hemorrhaging pediatric trauma patients, who may benefit from cryoprecipitate and/or platelet transfusions. TEG provides real-time information on coagulation status, which may expedite the delivery of specific blood products during trauma resuscitation. Level of evidence: Level III Type of study: Retrospective comparative study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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It is time for TEG in pediatric trauma: unveiling meaningful alterations in children who undergo massive transfusion

et al. 2021

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“…Erwägen Sie, während der Wiederbelebungsmaßnahmen von Kindern mit schwerem Trauma, Blutprodukte frühzeitig im Rahmen einer Strategie, die sich auf die Verbesserung der Gerinnung konzentriert, zu verabreichen [ 277 – 284 ]. Die Flüssigkeitstherapie wird von bestimmten Endpunkten (MAD, Laktat, Hb, klinische Beurteilung, pH-Wert, Gerinnung) geleitet, um eine Volumenüberladung zu vermeiden und dennoch eine ausreichende Gewebedurchblutung zu gewährleisten [ 285 – 287 ]. Daten von Erwachsenen legen nahe, dass eine übermäßig aggressive Flüssigkeitstherapie das Outcome verschlechtert, und unterstützen einen restriktiveren Ansatz, einschließlich einer permissiven Hypotonie [ 288 – 291 ].…”

Section: Evidenzen Für Die Leitlinienunclassified

Lebensrettende Maßnahmen bei Kindern (Paediatric Life Support, PLS)

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Die Leitlinien des European Resuscitation Council (ERC) zu den lebensrettenden Maßnahmen bei Kindern (Paediatric Life Support, PLS) basieren auf dem 2020 verfassten „International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations“ der ILCOR (International Liaison Committee on Resuscitation). Dieses Kapitel beinhaltet Leitlinien zur Behandlung kritisch kranker oder verletzter Säuglinge, von Kindern und Jugendlichen vor, während und nach einem Atem-Kreislauf-Stillstand.

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