title: Tranexamic Acid Use in United States Children's Hospitals.
abstract: BACKGROUND
  The prevalence of tranexamic acid (TXA) use for trauma and other conditions in children is unknown.
  
  
  OBJECTIVE
  The objective of this study was to describe the use of TXA in United States (US) children's hospitals for children in general, and specifically for trauma.
  
  
  METHODS
  We conducted a secondary analysis of a large, administrative database of 36 US children's hospitals. We included children <18 years of age who received TXA (based on pharmacy charge codes) between 2009 and 2013. Patients were grouped into the following diagnostic categories: trauma, congenital heart surgery, scoliosis surgery, craniosynostosis/craniofacial surgery, and other, based on the International Classification of Diseases, Ninth Revision principal procedure and diagnostic codes. TXA administration and dosage, in-hospital clinical variables, and diagnostic and procedure codes were documented.
  
  
  RESULTS
  A total of 35,478 pediatric encounters with a TXA charge were included in the study cohort. The proportions of children who received TXA were similar across the years 2009 to 2013. Only 110 encounters (0.31%) were for traumatic conditions. Congenital heart surgery accounted for more than one-half of the encounters (22,863; 64%). Overall, the median estimated weight-based dose of TXA was 22.4 mg/kg (interquartile range, 7.3-84.9 mg/kg).
  
  
  CONCLUSIONS
  We identified a wide frequency of use and range of doses of TXA for several diagnostic conditions in children. The use of TXA among injured children, however, appears to be rare despite its common use and efficacy among injured adults. Additional work is needed to identify appropriate indications for TXA and provide dosage guidelines among children with a variety of conditions, including trauma.
authors.affiliation: Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Nishijima
authors.affiliation: Division of Pediatric Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Monuteaux
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: David
authors.initials: D
authors.lastname: Faraoni
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Goobie
authors.affiliation: Division of Pediatric Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Lois
authors.initials: L
authors.lastname: Lee
authors.affiliation: Division of Trauma and Emergency Surgery, Department of Surgery, University of California Davis School of Medicine, Sacramento, California.
authors.forename: Joseph
authors.initials: J
authors.lastname: Galante
authors.affiliation: Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California.
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
authors.affiliation: Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California; Department of Pediatrics, University of California Davis School of Medicine, Sacramento, California.
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
mesh_terms: D000933:Antifibrinolytic Agents / Q000494:pharmacology / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006776:Hospitals, Pediatric / Q000458:organization & administration; D006801:Humans; D007223:Infant; D008297:Male; D010372:Pediatrics / Q000379:methods; D015995:Prevalence; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D014481:United States; D014947:Wounds and Injuries / Q000175:diagnosis
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: child; tranexamic acid; wounds and injuries