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Authors Magoteaux SR, Notrica DM, Langlais CS, Linnaus ME, Raines AR, Letton RW, Alder AC, Greenwell C, Eubanks JW, Lawson KA, Garcia NM, St Peter SD, Ostlie DJ, Leys CM, Bhatia A, Maxson RT, Tuggle DW, Ponsky TA
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Journal J. Pediatr. Surg. Volume: 52 Issue: 6 Pages: 979-983
Publish Date 2017 Jun
PubMed ID 28363471
Abstract

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.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.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.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.Secondary analysis of a prospective observational study.Level IV cohort study.

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