title: Massive transfusion in pediatric trauma: analysis of the National Trauma Databank.
abstract: Massive transfusion (MT) in pediatric trauma has been described in combat populations and other single institutions studies. We aim to define the incidence of MT in a large US civilian pediatric trauma population, identify predictive parameters of MT, and the mortality associated with MT.
  
  
  
  Data from the National Trauma Databank (2010-2012), a trauma registry maintained by the American College of Surgeons, were analyzed. We included pediatric trauma patients ≤14 y that underwent MT, as defined by 40 mL/kg of blood products within the first 24 h after admission. We compared the MT group with children receiving any transfusion within the same time frame. Univariate and multivariate analysis were performed.
  
  
  
  Of 356,583 pediatric trauma patients, 13,523 (4%) received any transfusion in the first 24 h and 173 (0.04%) had a MT. On multivariate analysis, factors predicting MT were: older patients (5-12: OR 2.71, P = 0.006, and ≥12: OR 5.14, P < 0.001), hypothermic patients (temperature <35: OR 2.48, P < 0.025), low Glasgow Coma Scale (Glasgow Coma Scale <8: OR 2.82, P = 0.009), and Injury Severity Scores ≥25 (OR 2.01, P = 0.03). Overall mortality for the entire group, any transfusion group, and MT group were 2.5%, 13.6%, and 50.6%, respectively (P < 0.001).
  
  
  
  MT in pediatric trauma is an uncommon event associated with a significant mortality. Patients undergoing MT are older, more likely to be hypothermic and have sustained more severe injuries as measured by traditional trauma scoring systems than transfused trauma patients.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Shroyer
authors.affiliation: Department of Epidemiology, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Russell L
authors.initials: RL
authors.lastname: Griffin
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Vincent E
authors.initials: VE
authors.lastname: Mortellaro
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: robert.russell@childrensal.org.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Russell
mesh_terms: D000293:Adolescent; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D014947:Wounds and Injuries / Q000628:therapy*
keywords: Massive transfusion; Pediatric; Trauma