Aims and Objectives Major haemorrhage is a preventable cause of morbidity and mortality in paediatric trauma populations. We aimed to characterise the presentation, initial management and outcomes of children with major trauma haemorrhage.

Method and Design All paediatric (<16y) major haemorrhage protocol (MHP) patients included in the UK Trauma Audit & Research Network database admitted to the Royal London Hospital (February 2012 – January 2022) were included. Definitions of hypotension and tachycardia used Advanced Paediatric Life Support values. Coagulopathy was defined as INR >1.2. The primary outcome was survival to hospital discharge.

Results and Conclusion We identified 54 paediatric MHP patients, around half of which (43%) were aged 12 years and under. There was a clear difference in injury patterns, with the majority of children ≤12y sustaining blunt trauma (87%), including road traffic collisions (61%) and falls (13%), with 81% of those >12y presenting with penetrating injuries (81%). Age cohorts were separated for analysis.

Most MHP activations occurred prehospital irrespective of age (≤12y:91%, >12y:81%). Vital signs were poor indicators of haemorrhage, with less than half of children presenting with tachycardia (≤12y:45%, >12y:47%) and one third with hypotension (≤12y:35%, >12y:29%).

One in four children ≤12y were coagulopathic on admission rising to one third of children >12y (36%). Older children were more likely to receive a transfusion: red blood cells (>12y:65% vs ≤12y:39%), fresh frozen plasma (>12y:48% vs ≤12y:17%), platelets (>12y:29% vs ≤12y:8.7%) and cryoprecipitate (>12y:29% vs ≤12y:17%). Children over 12y were more likely to go directly to theatre (>12y:55% vs ≤12y:35%). Unadjusted survival to hospital discharge was ≤12y:83% and >12y:87%.

Classical signs of major haemorrhage in children are often absent, despite significant numbers needing transfusion and transfer to theatre from the emergency department. Further work to characterise this population and any opportunities for quality improvement on a national level is needed.