Timing and Volume of Crystalloid and Blood Products in Pediatric Trauma Multicenter Prospective Observational Study.

BACKGROUND: The purpose of this study was to determine the relationship between timing and volume of crystalloid prior to blood products and mortality, hypothesizing that earlier transfusion and decreased crystalloid prior to transfusion would be associated with improved outcomes. METHODS: A multi-institutional prospective observational study of pediatric trauma patients 1 crystalloid bolus required transfusion. Patients who received blood first (n=41) had shorter median time to transfusion (19.8 vs 78.0 minutes, p=.005) and less total fluid volume (50.4 vs 86.6 mL/kg, p=.033) than those who received crystalloid first despite similar ISS (median 22 vs 27, p=.40). On multivariable analysis there was no association with mortality (p=.51) however each crystalloid bolus after the first was incrementally associated with increased odds of extended ventilator, ICU, and hospital days (all p 1 crystalloid bolus was associated with increased need for transfusion and worse outcomes including extended duration of mechanical ventilation and hospitalization in this prospective study. These data support a crystalloid-sparing, early transfusion approach for resuscitation of injured children. LEVEL OF EVIDENCE: Level III, Therapeutic.