Hypotension and the need for transfusion in pediatric blunt spleen and liver injury: An ATOMAC+ prospective study

Summer R. Magoteaux, David M. Notrica, Crystal S. Langlais, Maria E. Linnaus, Alexander R. Raines, Robert W. Letton, Adam C. Alder, Cynthia Greenwell, James W. Eubanks, Karla A. Lawson, Nilda M. Garcia, Shawn D. St. Peter, Daniel J. Ostlie, Charles M. Leys, Amina Bhatia, R. Todd Maxson, David W. Tuggle, Todd A. Ponsky

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: 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. Methods: Secondary analysis of a 10-institution prospective observational study was performed of patients 18. years and younger presenting with BLSI. Patients with central nervous system (CNS) injury were excluded. Children receiving blood transfusion within 4. h of injury were evaluated. Time to first transfusion, vital signs, and physical exams were analyzed. Patients with hypotension were compared to those without hypotension. Results: 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 (2. h vs. 2.5. h, p = 0.107). The hypotensive group was older (median 15.0 versus 9.5. years; p = 0.007). Median transfusion volume in the first 24. h was 18.2. mL/kg (IQR: 9.6, 25.7) for those with hypotension and 13.9. mL/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. Conclusion: 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. Type of study: Secondary analysis of a prospective observational study. Level of evidence: Level IV cohort study.

Original languageEnglish (US)
JournalJournal of Pediatric Surgery
DOIs
StateAccepted/In press - Feb 23 2017

Fingerprint

Hypotension
Spleen
Prospective Studies
Pediatrics
Liver
Wounds and Injuries
Observational Studies
Nervous System Trauma
Hypovolemia
Vital Signs
Blood Transfusion
Cohort Studies
Central Nervous System
Mortality

Keywords

  • Hypotension
  • Injury
  • Pediatric
  • Shock
  • Transfusion
  • Trauma

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Magoteaux, S. R., Notrica, D. M., Langlais, C. S., Linnaus, M. E., Raines, A. R., Letton, R. W., ... Ponsky, T. A. (Accepted/In press). Hypotension and the need for transfusion in pediatric blunt spleen and liver injury: An ATOMAC+ prospective study. Journal of Pediatric Surgery. https://doi.org/10.1016/j.jpedsurg.2017.03.021

Hypotension and the need for transfusion in pediatric blunt spleen and liver injury : An ATOMAC+ prospective study. / Magoteaux, Summer R.; Notrica, David M.; Langlais, Crystal S.; Linnaus, Maria E.; Raines, Alexander R.; Letton, Robert W.; Alder, Adam C.; Greenwell, Cynthia; Eubanks, James W.; Lawson, Karla A.; Garcia, Nilda M.; St. Peter, Shawn D.; Ostlie, Daniel J.; Leys, Charles M.; Bhatia, Amina; Maxson, R. Todd; Tuggle, David W.; Ponsky, Todd A.

In: Journal of Pediatric Surgery, 23.02.2017.

Research output: Contribution to journalArticle

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 2017, 'Hypotension and the need for transfusion in pediatric blunt spleen and liver injury: An ATOMAC+ prospective study', Journal of Pediatric Surgery. https://doi.org/10.1016/j.jpedsurg.2017.03.021
Magoteaux, Summer R. ; Notrica, David M. ; Langlais, Crystal S. ; Linnaus, Maria E. ; Raines, Alexander R. ; Letton, Robert W. ; Alder, Adam C. ; Greenwell, Cynthia ; Eubanks, James W. ; Lawson, Karla A. ; Garcia, Nilda M. ; St. Peter, Shawn D. ; Ostlie, Daniel J. ; Leys, Charles M. ; Bhatia, Amina ; Maxson, R. Todd ; Tuggle, David W. ; Ponsky, Todd A. / Hypotension and the need for transfusion in pediatric blunt spleen and liver injury : An ATOMAC+ prospective study. In: Journal of Pediatric Surgery. 2017.
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abstract = "Purpose: 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. Methods: Secondary analysis of a 10-institution prospective observational study was performed of patients 18. years and younger presenting with BLSI. Patients with central nervous system (CNS) injury were excluded. Children receiving blood transfusion within 4. h of injury were evaluated. Time to first transfusion, vital signs, and physical exams were analyzed. Patients with hypotension were compared to those without hypotension. Results: 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 (2. h vs. 2.5. h, p = 0.107). The hypotensive group was older (median 15.0 versus 9.5. years; p = 0.007). Median transfusion volume in the first 24. h was 18.2. mL/kg (IQR: 9.6, 25.7) for those with hypotension and 13.9. mL/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. Conclusion: 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. Type of study: Secondary analysis of a prospective observational study. Level of evidence: Level IV cohort study.",
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T2 - An ATOMAC+ prospective study

AU - Magoteaux, Summer R.

AU - Notrica, David M.

AU - Langlais, Crystal S.

AU - Linnaus, Maria E.

AU - Raines, Alexander R.

AU - Letton, Robert W.

AU - Alder, Adam C.

AU - Greenwell, Cynthia

AU - Eubanks, James W.

AU - Lawson, Karla A.

AU - Garcia, Nilda M.

AU - St. Peter, Shawn D.

AU - Ostlie, Daniel J.

AU - Leys, Charles M.

AU - Bhatia, Amina

AU - Maxson, R. Todd

AU - Tuggle, David W.

AU - Ponsky, Todd A.

PY - 2017/2/23

Y1 - 2017/2/23

N2 - Purpose: 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. Methods: Secondary analysis of a 10-institution prospective observational study was performed of patients 18. years and younger presenting with BLSI. Patients with central nervous system (CNS) injury were excluded. Children receiving blood transfusion within 4. h of injury were evaluated. Time to first transfusion, vital signs, and physical exams were analyzed. Patients with hypotension were compared to those without hypotension. Results: 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 (2. h vs. 2.5. h, p = 0.107). The hypotensive group was older (median 15.0 versus 9.5. years; p = 0.007). Median transfusion volume in the first 24. h was 18.2. mL/kg (IQR: 9.6, 25.7) for those with hypotension and 13.9. mL/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. Conclusion: 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. Type of study: Secondary analysis of a prospective observational study. Level of evidence: Level IV cohort study.

AB - Purpose: 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. Methods: Secondary analysis of a 10-institution prospective observational study was performed of patients 18. years and younger presenting with BLSI. Patients with central nervous system (CNS) injury were excluded. Children receiving blood transfusion within 4. h of injury were evaluated. Time to first transfusion, vital signs, and physical exams were analyzed. Patients with hypotension were compared to those without hypotension. Results: 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 (2. h vs. 2.5. h, p = 0.107). The hypotensive group was older (median 15.0 versus 9.5. years; p = 0.007). Median transfusion volume in the first 24. h was 18.2. mL/kg (IQR: 9.6, 25.7) for those with hypotension and 13.9. mL/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. Conclusion: 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. Type of study: Secondary analysis of a prospective observational study. Level of evidence: Level IV cohort study.

KW - Hypotension

KW - Injury

KW - Pediatric

KW - Shock

KW - Transfusion

KW - Trauma

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