From the Division of Trauma and Burn Surgery, Children's National Hospital, Washington, DC.
Pediatr Emerg Care. 2024 Feb 1;40(2):124-127. doi: 10.1097/PEC.0000000000003118.
Timely transfusion is associated with improved survival and a reduction in in-hospital morbidity. The benefits of early hemorrhagic shock recognition may be limited by barriers to accessing blood products and their timely administration. We examined how pediatric trauma programs obtain blood products, the types of rapid infusion models used, and the metrics tracked to improve transfusion process efficiency in their emergency department (ED).
We developed and distributed a self-report survey to members of the Pediatric Trauma Society. The survey consisted of 6 initial questions, including the respondent's role and institution, whether a blood storage refrigerator was present in their ED, the rapid infuser model used to transfuse critically injured children in their ED, if their program tracked 4 transfusion process metrics, and if a video recording system was present in the trauma bay. Based on these responses, additional questions were prompted with an option for a free-text response.
We received 137 responses from 77 institutions. Most pediatric trauma programs have a blood storage refrigerator in the ED (n = 46, 59.7%) and use a Belmont rapid infuser to transfuse critically injured children (n = 45, 58.4%). The American College of Surgeons Level 1 designated trauma programs, or state-based equivalents, and "pediatric" trauma programs were more likely to have video recording systems for performance improvement review compared with lower designated trauma programs and "combined pediatric and adult" trauma programs, respectively.
Strategies to improve the timely acquisition and infusion of blood products to critically injured children are underreported. This study examined the current practices that pediatric trauma programs use to transfuse critically injured children and may provide a resource for trauma programs to cite for transfusion-related quality improvement.
及时输血与存活率提高和住院期间发病率降低相关。早期识别出血性休克的益处可能会受到获取血液制品及其及时给药的障碍限制。我们研究了儿科创伤项目如何在其急诊科获得血液制品、使用的快速输注模型类型，以及跟踪哪些指标来提高输血过程的效率。
我们开发并向儿科创伤学会成员分发了一份自我报告调查。该调查由 6 个初始问题组成，包括受访者的角色和机构、其急诊科是否有血液储存冰箱、用于在急诊科输注严重受伤儿童的快速输注器模型、其项目是否跟踪 4 个输血过程指标，以及创伤室是否有视频记录系统。根据这些回答，会有其他问题提示，并提供了一个自由文本回复选项。
我们从 77 个机构收到了 137 份回复。大多数儿科创伤项目在急诊科都有血液储存冰箱（n = 46，59.7%），并且使用 Belmont 快速输注器来输注严重受伤的儿童（n = 45，58.4%）。美国外科医师学院 1 级指定创伤项目或州级同等项目，以及“儿科”创伤项目与低级别指定创伤项目和“儿科和成人”混合创伤项目相比，更有可能为绩效改进审查配备视频记录系统。
改善严重受伤儿童及时获得和输注血液制品的策略报告不足。本研究检查了儿科创伤项目用于输注严重受伤儿童的当前实践，并可能为创伤项目提供一个引用资源，以进行输血相关质量改进。
