Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado; Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.
The Center for Research in Outcomes for Children's Surgery, Center for Children's Surgery, University of Colorado School of Medicine, Aurora, Colorado.
J Surg Res. 2023 Feb;282:232-238. doi: 10.1016/j.jss.2022.10.007. Epub 2022 Oct 31.
Increased blood volumes, due to massive transfusion (MT), are known to be associated with both infectious and noninfectious adverse outcomes. The aim of this study was to assess the association between MT and outcomes in pediatric trauma patients, and, secondarily, determine if these outcomes are differential by age once MT is reached.
Pediatric patients (ages 1-18 y old) in the ACS pediatric Trauma Quality Improvement Program (TQIP) database (2015-2018) who received blood were included. Patients were stratified by MT status, which was defined as blood product volume of 40 mL/kg within 24 h of admission (MT+) and compared to children who received blood products but did not meet the MT threshold (MT-). Defined MT + patients were matched 1:1 to MT-patients via propensity score matching of characteristics before comparisons. Adjusted logistic regression was performed on univariably significant outcomes of interest.
There were 2318 patients in the analytic cohort. Patients who received MT had higher rates of deep venous thrombosis (DVT) (2.5% versus 1.0%, P < 0.001), acute kidney injury (AKI) (1.5% versus 0.0%, P = 0.022), CLABSI (4.0% versus 2.0% P = 0.008), and severe sepsis (2.3% versus. 1.1%, P = 0.02). On logistic regression MT was an independent risk factor for these outcomes. There was no differential effect of MT on these outcomes based on age.
Outcomes associated with blood transfusion in pediatric trauma patients are low overall, but rates of DVT, AKI, CLABSI, and sepsis are higher in those who receive MT+ with no differences based on age.
大量输血（MT）会导致血容量增加，已知其与感染性和非感染性不良结局均相关。本研究旨在评估 MT 与儿科创伤患者结局之间的关联，并在达到 MT 后，确定这些结局是否因年龄而异。
纳入美国外科医师学会儿科创伤质量改进计划（TQIP）数据库（2015-2018 年）中接受输血的 1-18 岁儿科患者。根据 MT 状态对患者进行分层，MT 定义为入院 24 小时内血液制品用量达到 40ml/kg（MT+），并与未达到 MT 阈值的接受血液制品的患儿（MT-）进行比较。对 MT+患者进行 1:1 倾向性评分匹配，以匹配 MT-患者的特征，然后进行比较。对有意义的单变量结局进行调整后逻辑回归分析。
分析队列中共有 2318 例患者。接受 MT 的患者深静脉血栓形成（DVT）发生率较高（2.5%比 1.0%，P<0.001），急性肾损伤（AKI）发生率较高（1.5%比 0.0%，P=0.022），导管相关性血流感染（CLABSI）发生率较高（4.0%比 2.0%，P=0.008），严重脓毒症发生率较高（2.3%比 1.1%，P=0.02）。MT 是这些结局的独立危险因素。但根据年龄，MT 对这些结局没有差异。
儿科创伤患者输血相关结局总体较低，但接受 MT+的患者 DVT、AKI、CLABSI 和脓毒症的发生率较高，且与年龄无关。
