دورية أكاديمية
Association of Prehospital Transfusion With Mortality in Pediatric Trauma
| العنوان: | Association of Prehospital Transfusion With Mortality in Pediatric Trauma |
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| المؤلفون: | Morgan, Katrina M., Abou-Khalil, Elissa, Strotmeyer, Stephen, Richardson, Ward M., Gaines, Barbara A., Leeper, Christine M. |
| المصدر: | JAMA Pediatrics ; volume 177, issue 7, page 693 ; ISSN 2168-6203 |
| بيانات النشر: | American Medical Association (AMA) |
| سنة النشر: | 2023 |
| الوصف: | Importance Optimal hemostatic resuscitation in pediatric trauma is not well defined. Objective To assess the association of prehospital blood transfusion (PHT) with outcomes in injured children. Design, Setting, and Participants This retrospective cohort study of the Pennsylvania Trauma Systems Foundation database included children aged 0 to 17 years old who received a PHT or emergency department blood transfusion (EDT) from January 2009 and December 2019. Interfacility transfers and isolated burn mechanism were excluded. Analysis took place between November 2022 and January 2023. Exposure Receipt of a blood product transfusion in the prehospital setting compared with the emergency department. Main Outcomes and Measures The primary outcome was 24-hour mortality. A 3:1 propensity score match was developed balancing for age, injury mechanism, shock index, and prehospital Glasgow Comma Scale score. A mixed-effects logistic regression was performed in the matched cohort further accounting for patient sex, Injury Severity Score, insurance status, and potential center-level heterogeneity. Secondary outcomes included in-hospital mortality and complications. Results Of 559 children included, 70 (13%) received prehospital transfusions. In the unmatched cohort, the PHT and EDT groups had comparable age (median [IQR], 47 [9-16] vs 14 [9-17] years), sex (46 [66%] vs 337 [69%] were male), and insurance status (42 [60%] vs 245 [50%]). The PHT group had higher rates of shock (39 [55%] vs 204 [42%]) and blunt trauma mechanism (57 [81%] vs 277 [57%]) and lower median (IQR) Injury Severity Score (14 [5-29] vs 25 [16-36]). Propensity matching resulted in a weighted cohort of 207 children, including 68 of 70 recipients of PHT, and produced well-balanced groups. Both 24-hour (11 [16%] vs 38 [27%]) and in-hospital mortality (14 [21%] vs 44 [32%]) were lower in the PHT cohort compared with the EDT cohort, respectively; there was no difference in in-hospital complications. Mixed-effects logistic regression in the postmatched group ... |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| DOI: | 10.1001/jamapediatrics.2023.1291 |
| الإتاحة: | https://doi.org/10.1001/jamapediatrics.2023.1291Test https://jamanetwork.com/journals/jamapediatrics/articlepdf/2805185/jamapediatrics_morgan_2023_oi_230020_1688135448.63188.pdfTest |
| رقم الانضمام: | edsbas.1C998587 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1001/jamapediatrics.2023.1291 |
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