Abstract
PurposeTrauma is the leading cause of death in children. In adults, blood transfusion and fluid resuscitation protocols changed resulting in a decrease of morbidity and mortality over the past 2 decades. Here, transfusion and fluid resuscitation practices were analysed in severe injured children in Germany.MethodsSeverely injured children (maximum Abbreviated Injury Scale (AIS) ≥ 3) admitted to a certified trauma-centre (TraumaZentrum DGU®) between 2002 and 2017 and registered at the TraumaRegister DGU® were included and assessed regarding blood transfusion rates and fluid therapy.Results5,118 children (aged 1–15 years) with a mean ISS 22 were analysed. Blood transfusion rates administered until ICU admission decreased from 18% (2002–2005) to 7% (2014–2017). Children who are transfused are increasingly seriously injured. ISS has increased for transfused children aged 1–15 years (2002–2005: mean 27.7–34.4 in 2014–2017). ISS in non-transfused children has decreased in children aged 1–15 years (2002–2005: mean 19.6 to mean 17.6 in 2014–2017). Mean prehospital fluid administration decreased from 980 to 549 ml without affecting hemodynamic instability.ConclusionBlood transfusion rates and amount of fluid resuscitation decreased in severe injured children over a 16-year period in Germany. Restrictive blood transfusion and fluid management has become common practice in severe injured children. A prehospital restrictive fluid management strategy in severely injured children is not associated with a worsened hemodynamic state, abnormal coagulation or base excess but leads to higher hemoglobin levels.
Highlights
Trauma is the leading cause of death in children [1], with severe haemorrhage as the primary contributing factor [2,3,4]
While blood transfusion rates in serious injured adults decreased over the last decade and were associated with a reduction in morbidity and mortality [5], there are no sufficient data that confirm a similar change in practice in children
Positive fluid balance has been associated with higher mortality rates in adult trauma patients (5), but no data for fluid management in paediatric trauma patients are available
Summary
Trauma is the leading cause of death in children [1], with severe haemorrhage as the primary contributing factor [2,3,4]. With several risks resulting in significant morbidity and mortality (3) Treatment of those severely injured children is a challenge due to differences in physiology and anatomy. Fluid and transfusion management plays an important role in resuscitation of severe haemorrhage in children. While blood transfusion rates in serious injured adults decreased over the last decade and were associated with a reduction in morbidity and mortality [5], there are no sufficient data that confirm a similar change in practice in children. That similar to adults, seriously injured children receive less blood transfusion and less fluids. This hypothesis was tested by an analysis of the TraumaRegister DGU® (TR-DGU)
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