Rosenfeld Eric, Lau Patricio, Zhang Wei, Russell Robert T, Shah Sohail R, Naik-Mathuria Bindi, Vogel Adam M
Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
Outcomes & Impact Service, Texas Children's Hospital, Houston, TX.
J Pediatr Surg. 2019 May;54(5):975-979. doi: 10.1016/j.jpedsurg.2019.01.029. Epub 2019 Jan 31.
The purpose of this study was to identify an optimal definition of massive transfusion (MT) in civilian pediatric trauma.
Severely injured children (age ≤18 years, injury severity score ≥25) in the Trauma Quality Improvement Program research datasets 2014-2015 that received blood products were identified. Children with traumatic brain injury and non-survivable injuries were excluded. Early mortality was defined as death within 24 h and delayed mortality as death after 24 h from hospital admission. Receiver operating curves and sensitivity and specificity analysis identified an MT threshold. Continuous variables are presented as median [IQR].
Of the 270 included children, the overall mortality was 27% (N = 74). There were no differences in demographics or mechanism of injury between children that lived or died. Sensitivity and specificity for early mortality was optimized at a 4-h transfusion volume of 37 ml/kg. After controlling for other significant variables, a threshold of 37 ml/kg/4 h predicted the need for a hemorrhage control procedure (OR 8.60; 95% CI 4.25-17.42; p < 0.01) and early mortality (OR 4.24; 95% CI 1.96-9.16; p < 0.01).
An MTP threshold of 37 mL/kg/4 h of transfused blood products predicted the need for hemorrhage control procedures and early mortality. This threshold may provide clinicians with a timely prognostic indicator, improve research methodology, and resource utilization.
Diagnostic Test.
III.
本研究旨在确定平民儿科创伤中大量输血（MT）的最佳定义。
在2014 - 2015年创伤质量改进项目研究数据集中，确定接受血液制品的重伤儿童（年龄≤18岁，损伤严重程度评分≥25）。排除创伤性脑损伤和不可存活损伤的儿童。早期死亡率定义为入院后24小时内死亡，延迟死亡率定义为入院24小时后死亡。通过受试者工作特征曲线以及敏感性和特异性分析确定MT阈值。连续变量以中位数[四分位间距]表示。
纳入的270名儿童中总死亡率为27%（N = 74）。存活或死亡儿童在人口统计学或损伤机制方面无差异。早期死亡率的敏感性和特异性在4小时输血量为37 ml/kg时达到最佳。在控制其他显著变量后，37 ml/kg/4小时的阈值可预测出血控制程序的需求（比值比8.60；95%置信区间4.25 - 17.42；p < 0.01）和早期死亡率（比值比4.24；95%置信区间1.96 - 9.16；p < 0.01）。
输血制品37 mL/kg/4小时的大量输血方案（MTP）阈值可预测出血控制程序的需求和早期死亡率。该阈值可为临床医生提供及时的预后指标，改善研究方法和资源利用。
诊断试验。
III级。
