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Management of Trauma Induced Coagulopathy and Massive Transfusion in Pediatric Trauma2017

Type: New Practice Management Guideline (PMG)
Category: Surgical Critical Care
Committee Liaison: Christopher Dodgion, MD, MSPH, MBA


Team leader(s)

Trauma induced coagulopathy (TIC) in children is common and results to significant morbidity and mortality. Massive transfusion (MT) in the setting of massive transfusion protocols (MTP) in adults have been shown to improve mortality, morbidity, and blood product utilization. TIC and MT are intimately related. There are no evidence based guidelines available for the management of trauma induced coaguloapthy or massive transfusion in children.

PICO 1 -  In severely injured pediatric trauma patients with trauma-induced coagulopathy (TIC) (P), are viscoelastic monitoring (VEM) abnormalities (I) better than conventional coagulation tests (CCT) abnormalities (C) for predicting any mortality, multisystem organ failure, ventilator-free days, or total blood products transfused (O)?

PICO 2 - In severely injured pediatric trauma patients with TIC (P), is goal directed hemostatic resuscitation using VEM (I) compared to CCT/standard of care (C) result in decreased mortality (any), decreased total blood products transfused, decreased multisystem organ failure, or increased ventilator-free days?

PICO 3 - In severely injured pediatric trauma patients with TIC (P), should a high ratio (as close as possible to 1:1:1) of plasma and platelets to red blood cells (I) compared to a low ratio (less than 1:1:2) of plasma and platelets to red blood cells (C) be administered to reduce any mortality, total blood products transfused, multisystem organ failure, or increased ventilator-free days?

PICO 4 - In severely injured pediatric trauma patients with TIC (P), does massive transfusion protocol (MTP) activation compared to no MTP activation (C) result in decreased mortality, decreased total blood product use, decreased multisystem organ failure, or increased ventilator-free days?

This PMG is a collaboration between EAST and the Pediatric Trauma Society.

Working Group Members
Adam M. Vogel, MD - Team Leader
Marc Auerbach, MD, MSCI - Chair, Pediatric Trauma Society Guidelines Committee
Matthew Borgman, MD
Nathan Christopher, RN, MBA, CEN, CEN, NR-Paramedic
Christopher Dodgion, MD, MSPH, MBA
Robert Finkelstein, MD
Keran Gibbs, MSN, MPH
Ankush Gosain, MD, PhD
Arash Mahajerin, MD
Mark McCollum, MD
Ian Mitchell, MD
Bryce Robinsonk, MD, MS
Robert T. Russell, MD, MPH
Christian J. Streck, Jr., MD
Rajan Thakkar, MD
Regan Williams


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