title: Adult-Based Massive Transfusion Protocol Activation Criteria Do Not Work in Children.
abstract: IntroductionIn the adult population, assessment of blood consumption (ABC) score [penetrating mechanism, positive focused assessment sonography for trauma (FAST), systolic blood pressure < 90, and heart rate (HR) > 120] ≥2 identifies trauma patients who require massive transfusion (MT) with sensitivity and specificity of 75 and 86%. We hypothesized that the adult criteria cannot be applied to children, as the vital sign cut-offs are not age-adjusted. We aimed to determine if the use of a shock index, pediatric age-adjusted (SIPA) would improve the discriminate ability of the ABC score in children.Materials and MethodsA retrospective review of children age 4 to 15 who received a packed red blood cell (PRBC) transfusion during admission for trauma between 2008 and 2014 was performed. We compared the sensitivity and specificity of ABC score ≥ 2, elevated SIPA, and age-adjusted ABC score (ABC-S) utilizing SIPA in place of HR and BP, to determine the need for MT.ResultsA total of 50 children were included, 31 received PRBC transfusion within 6 hours of injury, 7 children had a positive FAST, and 3 suffered penetrating trauma, all in the early transfusion group. ABC score ≥ 2 is 29% sensitive and 100% specific at predicting need for MT while ABC-S score ≥ 1 is 65% sensitive and 84% specific.ConclusionsAdult-based criteria for activation of MT perform poorly in the pediatric population. The use of SIPA modestly improves the sensitivity of the ABC score in children; however, the sensitivity and specificity of this score are still worse than when used in an adult population. This suggests the need to develop a new score that takes into account the low rate of penetrating trauma and positive FAST in the pediatric population.
authors.affiliation: Department of General Surgery, University of Colorado, Aurora, Colorado, United States.
authors.forename: Shannon N
authors.initials: SN
authors.lastname: Acker
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado, United States.
authors.forename: Brianne
authors.initials: B
authors.lastname: Hall
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado, United States.
authors.forename: Lauren
authors.initials: L
authors.lastname: Hill
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado, United States.
authors.forename: David A
authors.initials: DA
authors.lastname: Partrick
authors.affiliation: Department of Surgery, Denver Health Medical Center, Aurora, Colorado, United States.
authors.forename: Denis D
authors.initials: DD
authors.lastname: Bensard
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D017707:Erythrocyte Transfusion / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012771:Shock, Hemorrhagic / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications*