ABSTRACT 756

Abstract

Background and aims: Trauma is a leading worldwide cause of death and disability in all age groups and is the principal cause of death among children and young adults aged 44 and under. Every year across England and Wales 10,000 people die after trauma, and around 40% of these deaths are due to haemorrhage or its consequences, making bleeding the leading cause of potentially preventable death. Systematic reviews show mixed evidence for volume replacement in major haemorrhage in trauma, and a 2011 review by Curry et al identified a deficiency of Randomised Controlled Trials in the field. A 2012 systematic review identified improved survival associated with the use of massive blood transfusion (MBT) protocols on survival at 24 hour and 30 day time points; a prospective analysis of MBT amongst trauma patients in the TARN network in 2012 showed that only 0.4% of trauma patients in the UK required MBT, but that mortality amongst this group was 40.3%. Major Haemorrhage Protocols (MHPs) are now a widely used in the UK to ensure timely provision of blood products to patients with active haemorrhage. Aims: To examine the range of practice for MHPs for Children in England’s combined adult and paediatric Major Trauma Centres (MTCs). Methods: Major Haemorrhage Protocols were volunteered from each of the MTCs. Results: Paediatric specific MHPs were examined for reasons for activation, intended use of blood products and their ratios, and targeted outcome measures. Conclusions: The analysis of practice shows wide variation between MHPs. It is not known how this affects outcome.