A prospective review of transfusion practices in paediatric trauma patients at level 1 trauma centre.

Abstract

Transfusion practices in paediatric trauma patients are frequently based on adult protocols, despite notable differences in physiology and injury mechanisms between children and adults. This study was aimed to evaluate the current transfusion practices, among the paediatric trauma population, which will help in guiding management and planning along with research opportunities among paediatric trauma patients MATERIALS AND METHODS: We conducted a prospective observational study over one year, including trauma patients under 18 years who received transfusions. Data collected encompassed demographics, clinical and injury details, transfusion specifics, and outcomes, with descriptive analyses and assessment of associations with clinical and laboratory parameters. Of the paediatric trauma patients, 394 (38.7%) received transfusions. Among these, 388 (98.5%) received PRBC, 159 (40.4%) RDP, 170 (43.2%) FFP, and 3 (0.8%) cryoprecipitate. Median requirements were 21.8 ml/kg PRBC, 5.8 ml/kg RDP, 17.5 ml/kg FFP, and 2.6 ml/kg cryoprecipitate. Early PRBC transfusions were associated with delayed admission, tachycardia, and low baseline haemoglobin. RDP and FFP correlated with higher injury scores, shock index, FAST/eFAST positivity, tachycardia, hypotension, Low Hb, and abnormal PT. Massive transfusion (≥40 ml/kg in 24 h) was required in 102 cases (25.9%), with most blood components administered within the first day. A substantial portion of paediatric trauma patients required transfusion, mainly plasma and platelets for severe bleeding. Transfusion need was linked to injury severity and clinical indicators. Early, targeted transfusion may improve outcomes for these vulnerable patients.