Defining Massive Transfusion in Civilian Pediatric Trauma With Traumatic Brain Injury

Eric H. Rosenfeld, Patricio Lau, Megan E. Cunningham, Wei Zhang, Robert T. Russell, Bindi Naik-Mathuria, Adam M. Vogel

Research output: Contribution to journalArticlepeer-review


Background: The purpose of this study was to identify an optimal definition of massive transfusion in civilian pediatric trauma with severe traumatic brain injury (TBI) Methods: Severely injured children (age ≤18 y) with severe TBI in the Trauma Quality Improvement Program research data sets 2015-2016 that received blood products were identified. Data were analyzed using descriptive statistics, Wilcoxon rank-sum, chi-square, and logistic regression. Continuous variables are presented as median (interquartile range). Massive transfusion thresholds were determined based on receiver operating curves and optimization of sensitivity and specificity Results: Of the 460 included children, the mortality rate was 43%. There were no differences in demographics, heart rate at presentation, or injury severity score between children that lived or died. However, those who died had lower Glasgow coma scores (3 [3, 8] versus 3 [3, 3]; P < 0.01), were more likely to have had a penetrating injury (20% versus 11%; P < 0.01) and were more likely to be hypotensive for age (62% versus 34%; P < 0.01). Total blood products infused were greater in those who died (34 mL/kg/4-h [17, 65] versus 22 [12, 44]; P < 0.01). Sensitivity and specificity for delayed mortality was optimized at 40 mL/kg/4 h, and for the need for a hemorrhage control procedure at 50 mL/kg/4 h. These thresholds predicted delayed mortality (OR 2.12; 95% CI 1.28-3.50; P < 0.01) and the need for hemorrhage control procedures (5.47; 95% CI 2.82-10.61; P < 0.01)

Original languageEnglish (US)
Pages (from-to)44-50
Number of pages7
JournalJournal of Surgical Research
StatePublished - Apr 2019
Externally publishedYes


  • Hemorrhage control
  • Mortality
  • Pediatric trauma
  • Traumatic brain injury
  • massive transfusion
  • massive transfusion protocol

ASJC Scopus subject areas

  • Surgery


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