Changes in transfusion and fluid therapy practices in severely injured children: an analysis of 5118 children from the TraumaRegister DGU®
- 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.
Author: | Florian PiekarskiORCiDGND, Jost KaufmannORCiDGND, Thomas EngelhardtGND, Florian RaimannORCiDGND, Thomas LustenbergerORCiDGND, Ingo MarziORCiDGND, Rolf LeferingORCiDGND, Kai ZacharowskiORCiDGND, Patrick MeybohmORCiDGND |
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URN: | urn:nbn:de:hebis:30:3-694478 |
DOI: | https://doi.org/10.1007/s00068-020-01423-z |
ISSN: | 1863-9941 |
Parent Title (English): | European journal of trauma and emergency surgery |
Publisher: | Springer Medizin |
Place of publication: | Heidelberg |
Document Type: | Article |
Language: | English |
Date of Publication (online): | 2020/06/29 |
Date of first Publication: | 2020/06/29 |
Publishing Institution: | Universitätsbibliothek Johann Christian Senckenberg |
Contributing Corporation: | TraumaRegister DGU |
Release Date: | 2023/03/06 |
Tag: | Fluid therapy; Mortality; Outcome; Paediatric trauma patients; Patient blood management; Serious injured children; Transfusion practice; TraumaRegister DGU® (TR-DGU); Volume therapy |
Volume: | 48 |
Issue: | 1 |
Page Number: | 9 |
First Page: | 373 |
Last Page: | 381 |
HeBIS-PPN: | 508512956 |
Institutes: | Medizin |
Dewey Decimal Classification: | 6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit |
Sammlungen: | Universitätspublikationen |
Licence (German): | Creative Commons - CC BY - Namensnennung 4.0 International |