Hypotension and the need for transfusion in pediatric blunt spleen and liver injury: An ATOMAC+ prospective study.

Creator(s)

Summer R. Magoteaux
David M. Notrica
Crystal S. Langlais
Maria E. Linnaus
Alexander R. Raines
Robert W. Letton
Adam C. Alder
Cynthia Greenwell
James W. Eubanks
Karla A. Lawson
Nilda M. Garcia
Shawn D. St Peter, Children's Mercy HospitalFollow
Daniel J. Ostlie
Charles M. Leys
Amina Bhatia
R Todd Maxson
David W. Tuggle
Todd A. Ponsky

Document Type

Article

Publication Date

6-1-2017

Identifier

DOI: 10.1016/j.jpedsurg.2017.03.021

Abstract

Purpose: Children with blunt liver or spleen injury (BLSI) requiring early transfusion may present without hypotension despite significant hypovolemia. This study sought to determine the relationship between early transfusion in pediatric BLSI and hypotension.

Methods: Secondary analysis of a 10-institution prospective observational study was performed of patients 18years and younger presenting with BLSI. Patients with central nervous system (CNS) injury were excluded. Children receiving blood transfusion within 4h of injury were evaluated. Time to first transfusion, vital signs, and physical exams were analyzed. Patients with hypotension were compared to those without hypotension.

Results: Of 1008 patients with BLSI, 47 patients met inclusion criteria. 22 (47%) had documented hypotension. There was no statistical difference in median time to first transfusion for those with or without hypotension (2h vs. 2.5h, p=0.107). The hypotensive group was older (median 15.0 versus 9.5years; p=0.007). Median transfusion volume in the first 24h was 18.2mL/kg (IQR: 9.6, 25.7) for those with hypotension and 13.9mL/kg (IQR: 8.3, 21.0) for those without (p=0.220). Mortality was 14% (3/22) in children with hypotension and 0% (0/25) in children without hypotension.

Conclusion: Hypotension occurred in less than half of patients requiring early transfusion following pediatric BLSI suggesting that hypotension does not consistently predict the need for early transfusion.

Type of study: Secondary analysis of a prospective observational study.

Level of evidence: Level IV cohort study.

Journal Title

Journal of pediatric surgery

Volume

52

Issue

6

First Page

979

Last Page

983

MeSH Keywords

Adolescent; Blood Transfusion; Case-Control Studies; Child; Child, Preschool; Female; Humans; Hypotension; Infant; Infant, Newborn; Liver; Male; Prospective Studies; Spleen; Time Factors; Wounds, Nonpenetrating

Keywords

Hypotension; Injury; Pediatric; Shock; Transfusion; Trauma; Low Blood Pressure

Recommended Citation

Magoteaux SR, Notrica DM, Langlais CS, et al. Hypotension and the need for transfusion in pediatric blunt spleen and liver injury: An ATOMAC+ prospective study. J Pediatr Surg. 2017;52(6):979-983. doi:10.1016/j.jpedsurg.2017.03.021