1
|
Johnson K, Upperman J. Utilization of REBOA for pediatric trauma patients: barriers to adoption. Trauma Surg Acute Care Open 2024; 9:e001579. [PMID: 39175841 PMCID: PMC11340704 DOI: 10.1136/tsaco-2024-001579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024] Open
Affiliation(s)
- Kevin Johnson
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Nasvhille, Tennessee, USA
| | | |
Collapse
|
2
|
Perea LL, Moore K, Docherty C, Nguyen U, Seamon MJ, Byrne JP, Jenkins DH, Braverman MA, Porter JM, Armento IG, Mentzer C, Leonard GC, Luis AJ, Noorbakhsh MR, Babowice JE, Kaafarani HMA, Mokhtari A, Martin MJ, Badiee J, Mains C, Madayag RM, Moore SA, Madden K, Hazelton JP. Whole Blood Resuscitation is Safe in Pediatric Trauma Patients: A Multicenter Study. Am Surg 2023:31348231157864. [PMID: 36792959 DOI: 10.1177/00031348231157864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Whole blood (WB) resuscitation has been associated with a mortality benefit in trauma patients. Several small series report the safe use of WB in the pediatric trauma population. We performed a subgroup analysis of the pediatric patients from a large prospective multicenter trial comparing patients receiving WB or blood component therapy (BCT) during trauma resuscitation. We hypothesized that WB resuscitation would be safe compared to BCT resuscitation in pediatric trauma patients. METHODS This study included pediatric trauma patients (0-17 y), from ten level-I trauma centers, who received any blood transfusion during initial resuscitation. Patients were included in the WB group if they received at least one unit of WB during their resuscitation, and the BCT group was composed of patients receiving traditional blood product resuscitation. The primary outcome was in-hospital mortality with secondary outcomes being complications. Multivariate logistic regression was performed to assess for mortality and complications in those treated with WB vs BCT. RESULTS Ninety patients, with both penetrating and blunt mechanisms of injury (MOI), were enrolled in the study (WB: 62 (69%), BCT: 28 (21%)). Whole blood patients were more likely to be male. There were no differences in age, MOI, shock index, or injury severity score between groups. On logistic regression, there was no difference in complications. Mortality was not different between the groups (P = .983). CONCLUSION Our data suggest WB resuscitation is safe when compared to BCT resuscitation in the care of critically injured pediatric trauma patients.
Collapse
Affiliation(s)
- Lindsey L Perea
- Department of Surgery, Division of Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Kate Moore
- Department of Surgery, Division of Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | | | - Uyen Nguyen
- 12310Penn State College of Medicine, Hershey, PA, USA
| | - Mark J Seamon
- 14640Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - James P Byrne
- 14640Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Donald H Jenkins
- 14742University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Maxwell A Braverman
- 14742University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | | | - Caleb Mentzer
- 7442Spartanburg Regional Healthcare System, Spartanburg, SC, USA
| | - Guy C Leonard
- 7442Spartanburg Regional Healthcare System, Spartanburg, SC, USA
| | | | | | | | | | - Ava Mokhtari
- 548305Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | | | | | | | - Joshua P Hazelton
- 12311Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|
3
|
Perrone PM, Milani GP, Dellepiane RM, Petaccia A, Prati D, Agostoni C, Marchisio PG, Castaldi S. Evaluation of Six Years of Appropriateness Level of Blood Transfusion in a Pediatric Ward. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1700. [PMID: 36767066 PMCID: PMC9914791 DOI: 10.3390/ijerph20031700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Blood transfusion can be considered as a life-saving treatment and is a primary health management topic. This study aims to assess the appropriateness of blood transfusion performed in a large tertiary hospital in Italy. METHODS a multispecialist team composed oof hematologists, public health experts and pediatricians analyzed blood transfusions performed between 2018 and 2022 in the pediatric wards comparing the appropriateness with the available NHS guidelines available. Patients' characteristics, clinical features and blood component's data were collected and analyzed. RESULTS considering 147 blood transfusions performed in 2018-2022, only eight (5.4%) were performed according to guidelines, while 98 (66.7%) were driven by clinicians' expertise, especially for anemia in genetic syndromes (30) (20.5%) and autoimmune diseases (20) (13.6%). Thirty-nine (26.5%) transfusions could be considered as inappropriate, while two (1.4%) blood packs were never been transfused after being requested. CONCLUSIONS This analysis is one of the first performed to assess the appropriateness of blood component transfusions comparing their compliance to NHS guidelines. The importance of this analysis can be explained first by the clinical point of view and second by the economic one.
Collapse
Affiliation(s)
- Pier Mario Perrone
- Department Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy
| | - Gregorio Paolo Milani
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | | | - Antonella Petaccia
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Daniele Prati
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Carlo Agostoni
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Paola Giovanna Marchisio
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Silvana Castaldi
- Department Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| |
Collapse
|