title: Hypotension and the need for transfusion in pediatric blunt spleen and liver injury: An ATOMAC+ prospective study.
abstract: OBJECTIVE
  Children with blunt liver or spleen injury (BLSI) requiring early transfusion may present without hypotension despite significant hypovolemia. This study sought to determine the relationship between early transfusion in pediatric BLSI and hypotension.
  
  
  METHODS
  Secondary analysis of a 10-institution prospective observational study was performed of patients 18years and younger presenting with BLSI. Patients with central nervous system (CNS) injury were excluded. Children receiving blood transfusion within 4h of injury were evaluated. Time to first transfusion, vital signs, and physical exams were analyzed. Patients with hypotension were compared to those without hypotension.
  
  
  RESULTS
  Of 1008 patients with BLSI, 47 patients met inclusion criteria. 22 (47%) had documented hypotension. There was no statistical difference in median time to first transfusion for those with or without hypotension (2h vs. 2.5h, p=0.107). The hypotensive group was older (median 15.0 versus 9.5years; p=0.007). Median transfusion volume in the first 24h was 18.2mL/kg (IQR: 9.6, 25.7) for those with hypotension and 13.9mL/kg (IQR: 8.3, 21.0) for those without (p=0.220). Mortality was 14% (3/22) in children with hypotension and 0% (0/25) in children without hypotension.
  
  
  CONCLUSIONS
  Hypotension occurred in less than half of patients requiring early transfusion following pediatric BLSI suggesting that hypotension does not consistently predict the need for early transfusion.
  
  
  METHODS
  Secondary analysis of a prospective observational study.
  
  
  METHODS
  Level IV cohort study.
authors.affiliation: Maricopa Integrated Health System, Phoenix, AZ, United States.
authors.forename: Summer R
authors.initials: SR
authors.lastname: Magoteaux
authors.affiliation: Phoenix Children's Hospital, Phoenix, AZ, United States. Electronic address: dnotrica@phoenixchildrens.com.
authors.forename: David M
authors.initials: DM
authors.lastname: Notrica
authors.affiliation: Phoenix Children's Hospital, Phoenix, AZ, United States.
authors.forename: Crystal S
authors.initials: CS
authors.lastname: Langlais
authors.affiliation: Phoenix Children's Hospital, Phoenix, AZ, United States.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Linnaus
authors.affiliation: Oklahoma University Health Sciences Center, Oklahoma City, OK, United States.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Raines
authors.affiliation: Oklahoma University Health Sciences Center, Oklahoma City, OK, United States.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Letton
authors.affiliation: Children's Medical Center Dallas, Dallas, TX, United States.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Alder
authors.affiliation: Children's Medical Center Dallas, Dallas, TX, United States.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Greenwell
authors.affiliation: University of Tennessee Health Science Center, Memphis, TN, United States.
authors.forename: James W
authors.initials: JW
authors.lastname: Eubanks
authors.affiliation: Dell Children's Medical Center, Austin, TX, United States.
authors.forename: Karla A
authors.initials: KA
authors.lastname: Lawson
authors.affiliation: Dell Children's Medical Center, Austin, TX, United States.
authors.forename: Nilda M
authors.initials: NM
authors.lastname: Garcia
authors.affiliation: Children's Mercy Hospital-University of Missouri, Kansas City, MO, United States.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
authors.affiliation: Phoenix Children's Hospital, Phoenix, AZ, United States.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ostlie
authors.affiliation: University of Wisconsin, Madison, WI, United States.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Leys
authors.affiliation: Children's Healthcare of Atlanta, Atlanta, GA, United States.
authors.forename: Amina
authors.initials: A
authors.lastname: Bhatia
authors.affiliation: Arkansas Children's Hospital, Little Rock, AR, United States.
authors.forename: R Todd
authors.initials: RT
authors.lastname: Maxson
authors.affiliation: Dell Children's Medical Center, Austin, TX, United States.
authors.forename: David W
authors.initials: DW
authors.lastname: Tuggle
authors.affiliation: Akron Children's Hospital, Akron, OH, United States.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Ponsky
mesh_terms: D000293:Adolescent; D001803:Blood Transfusion; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D007223:Infant; D007231:Infant, Newborn; D008099:Liver / Q000293:injuries*; D008297:Male; D011446:Prospective Studies; D013154:Spleen / Q000293:injuries*; D013997:Time Factors; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000401:mortality / Q000628:therapy*
keywords: Hypotension; Injury; Pediatric; Shock; Transfusion; Trauma