Changes in transfusion and fluid therapy practices in severely injured children: an analysis of 5118 children from the TraumaRegister DGU®.

PURPOSE

Trauma is the leading cause of death in children. In adults, blood transfusion and fluid resuscitation protocols changed resulting in a decrease of morbidity and mortality over the past 2 decades. Here, transfusion and fluid resuscitation practices were analysed in severe injured children in Germany.

METHODS

Severely injured children (maximum Abbreviated Injury Scale (AIS) ≥ 3) admitted to a certified trauma-centre (TraumaZentrum DGU®) between 2002 and 2017 and registered at the TraumaRegister DGU® were included and assessed regarding blood transfusion rates and fluid therapy.

RESULTS

5,118 children (aged 1-15 years) with a mean ISS 22 were analysed. Blood transfusion rates administered until ICU admission decreased from 18% (2002-2005) to 7% (2014-2017). Children who are transfused are increasingly seriously injured. ISS has increased for transfused children aged 1-15 years (2002-2005: mean 27.7-34.4 in 2014-2017). ISS in non-transfused children has decreased in children aged 1-15 years (2002-2005: mean 19.6 to mean 17.6 in 2014-2017). Mean prehospital fluid administration decreased from 980 to 549 ml without affecting hemodynamic instability.

CONCLUSION

Blood transfusion rates and amount of fluid resuscitation decreased in severe injured children over a 16-year period in Germany. Restrictive blood transfusion and fluid management has become common practice in severe injured children. A prehospital restrictive fluid management strategy in severely injured children is not associated with a worsened hemodynamic state, abnormal coagulation or base excess but leads to higher hemoglobin levels.