Aims To report the occurrence of major haemorrhage in children following major trauma, the practice of blood products transfusion including monitoring of laboratory parameters in such patients and the outcomes.
Methods We retrospectively analysed the local paediatric trauma database of all children following trauma call activation on arrival to the Emergency Department in a major urban trauma centre in London. We studies over a period of 15 months, May 2008–August 2009. We defined massive transfusion as packed red cells >40 ml/kg in the first 4 h or >80 ml/kg in the first 24 h.
Results 227 children presented to the accidents and emergency during this period following major trauma call activation. The median age at presentation was 10.2 years. 13 (5.7%) children had major haemorrhage. The median ISS WAS 35 (IQR 10–60). All but one were males. Three had penetrating trauma, one of whom made it to theatre but all died. Four had emergency damage control surgery. Abnormal results were seen in three patients, each having one abnormal result (INR=1.9 and APTT=86, low Hb=7.6, thrombocytopaenia =63). 8/13 patients received additional blood products such as Fresh Frozen Plasma (FFP), platelets and Cryoprecipitate. However, no patient received the ration of blood products RBC:FFP of 1:1 as practised in adult trauma. Two patients had no admission bloods done. Worsening coagulation parameters were seen in two patients when measure post-transfusion and the remaining 11 patients did not have routine monitoring of blood parameters post-transfusion. 8 (62%) patients died of which 7 died in the Emergency Department.
Conclusions Major haemorrhage is associated with a very high mortality in severely injured children. There is a need for instituting a major haemorrhage policy in paediatric trauma and consideration of point-of-care testing of blood parameters.
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