TY  - JOUR
A1  - Piekarski, Florian
A1  - Kaufmann, Jost
A1  - Engelhardt, Thomas
A1  - Raimann, Florian
A1  - Lustenberger, Thomas
A1  - Marzi, Ingo
A1  - Lefering, Rolf
A1  - Zacharowski, Kai
A1  - Meybohm, Patrick
T1  - Changes in transfusion and fluid therapy practices in severely injured children: an analysis of 5118 children from the TraumaRegister DGU®
T2  - European journal of trauma and emergency surgery
N2  - Purpose: Trauma 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.
Methods: Severely 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.
Results: 5,118 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.
Conclusion: Blood 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.
KW  - Paediatric trauma patients
KW  - Transfusion practice
KW  - Patient blood management
KW  - Outcome
KW  - Mortality
KW  - Fluid therapy
KW  - Volume therapy
KW  - Serious injured children
KW  - TraumaRegister DGU® (TR-DGU)
Y1  - 2020
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/69447
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-694478
SN  - 1863-9941
VL  - 48
IS  - 1
SP  - 373
EP  - 381
PB  - Springer Medizin
CY  - Heidelberg
ER  -