Initial hematocrit predicts the use of blood transfusion in the pediatric trauma patient

Casey J. Allen, Jun Tashiro, Evan J. Valle, Chad M. Thorson, Sherry Shariatmadar, Carl I Schulman, Holly Neville, Kenneth G Proctor, Juan E Sola

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Purpose Initial hematocrit (Hct) is generally not considered a marker of acute blood loss because it is assumed that physiologic response of fluid conservation to hemorrhage is delayed. We challenged this idea by theorizing that admission Hct correlates with conventional signs of shock and predicts the use of blood transfusion during resuscitation of pediatric trauma patients.

Methods Data from 1928 pediatric admissions (< 18 years) at a Level I trauma center (2000-2012) were compared using standard statistical analyses and logistic regression modeling to identify factors associated with blood transfusion during initial trauma resuscitation.

Results Overall mortality rate was 3.5%, with a transfusion rate of 10.7%. Factors significantly associated with transfusion were initial Hct, Glasgow Coma Score, base deficit, and injury severity score (all p < 0.001). Initial Hct is a stronger predictor for transfusion (area under receiver operator curve (AUC: 0.728) compared to age-specific tachycardia (AUC: 0.689), age-specific hypotension (AUC: 0.673), and altered mental status (AUC: 0.654)). On multivariate analysis, initial Hct was an independent predictor (OR [95% CI]: 2.94 [1.56, 5.52]) along with hypotension (6.37 [2.95, 13.8]), base deficit (4.14 [1.38, 12.4]), and tachycardia (3.07 [1.62, 5.81]).

Conclusions Initial Hct correlates significantly with conventional signs of shock and is a strong independent predictor for blood transfusion with better predictability than other clinical factors.

Original languageEnglish
Pages (from-to)1678-1682
Number of pages5
JournalJournal of Pediatric Surgery
Volume49
Issue number11
DOIs
StatePublished - Jan 1 2014

Fingerprint

Hematocrit
Blood Transfusion
Pediatrics
Area Under Curve
Wounds and Injuries
Tachycardia
Resuscitation
Hypotension
Shock
Injury Severity Score
Trauma Centers
Coma
Multivariate Analysis
Logistic Models
Regression Analysis
Hemorrhage
Mortality

Keywords

  • Adolescents
  • Children
  • Hematocrit
  • Kids
  • Transfusion

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Initial hematocrit predicts the use of blood transfusion in the pediatric trauma patient. / Allen, Casey J.; Tashiro, Jun; Valle, Evan J.; Thorson, Chad M.; Shariatmadar, Sherry; Schulman, Carl I; Neville, Holly; Proctor, Kenneth G; Sola, Juan E.

In: Journal of Pediatric Surgery, Vol. 49, No. 11, 01.01.2014, p. 1678-1682.

Research output: Contribution to journalArticle

Allen, Casey J. ; Tashiro, Jun ; Valle, Evan J. ; Thorson, Chad M. ; Shariatmadar, Sherry ; Schulman, Carl I ; Neville, Holly ; Proctor, Kenneth G ; Sola, Juan E. / Initial hematocrit predicts the use of blood transfusion in the pediatric trauma patient. In: Journal of Pediatric Surgery. 2014 ; Vol. 49, No. 11. pp. 1678-1682.
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abstract = "Purpose Initial hematocrit (Hct) is generally not considered a marker of acute blood loss because it is assumed that physiologic response of fluid conservation to hemorrhage is delayed. We challenged this idea by theorizing that admission Hct correlates with conventional signs of shock and predicts the use of blood transfusion during resuscitation of pediatric trauma patients.Methods Data from 1928 pediatric admissions (< 18 years) at a Level I trauma center (2000-2012) were compared using standard statistical analyses and logistic regression modeling to identify factors associated with blood transfusion during initial trauma resuscitation.Results Overall mortality rate was 3.5{\%}, with a transfusion rate of 10.7{\%}. Factors significantly associated with transfusion were initial Hct, Glasgow Coma Score, base deficit, and injury severity score (all p < 0.001). Initial Hct is a stronger predictor for transfusion (area under receiver operator curve (AUC: 0.728) compared to age-specific tachycardia (AUC: 0.689), age-specific hypotension (AUC: 0.673), and altered mental status (AUC: 0.654)). On multivariate analysis, initial Hct was an independent predictor (OR [95{\%} CI]: 2.94 [1.56, 5.52]) along with hypotension (6.37 [2.95, 13.8]), base deficit (4.14 [1.38, 12.4]), and tachycardia (3.07 [1.62, 5.81]).Conclusions Initial Hct correlates significantly with conventional signs of shock and is a strong independent predictor for blood transfusion with better predictability than other clinical factors.",
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AU - Shariatmadar, Sherry

AU - Schulman, Carl I

AU - Neville, Holly

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N2 - Purpose Initial hematocrit (Hct) is generally not considered a marker of acute blood loss because it is assumed that physiologic response of fluid conservation to hemorrhage is delayed. We challenged this idea by theorizing that admission Hct correlates with conventional signs of shock and predicts the use of blood transfusion during resuscitation of pediatric trauma patients.Methods Data from 1928 pediatric admissions (< 18 years) at a Level I trauma center (2000-2012) were compared using standard statistical analyses and logistic regression modeling to identify factors associated with blood transfusion during initial trauma resuscitation.Results Overall mortality rate was 3.5%, with a transfusion rate of 10.7%. Factors significantly associated with transfusion were initial Hct, Glasgow Coma Score, base deficit, and injury severity score (all p < 0.001). Initial Hct is a stronger predictor for transfusion (area under receiver operator curve (AUC: 0.728) compared to age-specific tachycardia (AUC: 0.689), age-specific hypotension (AUC: 0.673), and altered mental status (AUC: 0.654)). On multivariate analysis, initial Hct was an independent predictor (OR [95% CI]: 2.94 [1.56, 5.52]) along with hypotension (6.37 [2.95, 13.8]), base deficit (4.14 [1.38, 12.4]), and tachycardia (3.07 [1.62, 5.81]).Conclusions Initial Hct correlates significantly with conventional signs of shock and is a strong independent predictor for blood transfusion with better predictability than other clinical factors.

AB - Purpose Initial hematocrit (Hct) is generally not considered a marker of acute blood loss because it is assumed that physiologic response of fluid conservation to hemorrhage is delayed. We challenged this idea by theorizing that admission Hct correlates with conventional signs of shock and predicts the use of blood transfusion during resuscitation of pediatric trauma patients.Methods Data from 1928 pediatric admissions (< 18 years) at a Level I trauma center (2000-2012) were compared using standard statistical analyses and logistic regression modeling to identify factors associated with blood transfusion during initial trauma resuscitation.Results Overall mortality rate was 3.5%, with a transfusion rate of 10.7%. Factors significantly associated with transfusion were initial Hct, Glasgow Coma Score, base deficit, and injury severity score (all p < 0.001). Initial Hct is a stronger predictor for transfusion (area under receiver operator curve (AUC: 0.728) compared to age-specific tachycardia (AUC: 0.689), age-specific hypotension (AUC: 0.673), and altered mental status (AUC: 0.654)). On multivariate analysis, initial Hct was an independent predictor (OR [95% CI]: 2.94 [1.56, 5.52]) along with hypotension (6.37 [2.95, 13.8]), base deficit (4.14 [1.38, 12.4]), and tachycardia (3.07 [1.62, 5.81]).Conclusions Initial Hct correlates significantly with conventional signs of shock and is a strong independent predictor for blood transfusion with better predictability than other clinical factors.

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