title: The impact of blood product ratios in massively transfused pediatric trauma patients.
abstract: BACKGROUND
  Few studies have examined the impact of balanced resuscitation in pediatric trauma patients requiring massive transfusions. Adult data may not be generalizable to children.
  
  
  METHODS
  Retrospective analysis assessed patients seen at a level I trauma center between 2003 and 2010 aged ≤18 years requiring massive packed red blood cell (PRBC) transfusion, defined as transfusion of ≥50% total blood volume. After excluding mortalities in the first 24 hours, the impact of plasma and platelet ratios on mortality was evaluated.
  
  
  RESULTS
  Of 6,675 pediatric trauma patients, 105 were massively transfused (mean age, 12.4 ± 6.3 years; mean Injury Severity Score, 25.8 ± 11.4; mortality rate, 18.1%). All deceased patients sustained severe head injuries. Plasma/PRBC and platelet/PRBC ratios were not significantly associated with mortality.
  
  
  CONCLUSIONS
  In this study, higher plasma/PRBC and platelet/PRBC ratios were not associated with increased survival in children. The value of aggressive blood product transfusion for injured pediatric patients requires further prospective validation.
authors.affiliation: Department of Surgery, Keck School of Medicine, University of Southern California, LAC+USC Medical Center, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA 90033, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Nosanov
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Obi
authors.initials: O
authors.lastname: Okoye
authors.forename: Shelby
authors.initials: S
authors.lastname: Resnick
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Upperman
authors.forename: Ira
authors.initials: I
authors.lastname: Shulman
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D016913:Blood Component Transfusion; D001792:Blood Platelets; D001810:Blood Volume; D002140:California / Q000453:epidemiology; D002648:Child; D006259:Craniocerebral Trauma / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D015999:Multivariate Analysis; D010949:Plasma; D012189:Retrospective Studies; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000453:epidemiology / Q000628:therapy
keywords: Coagulopathy; Hemorrhage; Massive transfusion protocol; Pediatrics; Trauma