Pediatric traumatic hemorrhagic shock consensus conference research priorities.
Journal
The journal of trauma and acute care surgery
ISSN: 2163-0763
Titre abrégé: J Trauma Acute Care Surg
Pays: United States
ID NLM: 101570622
Informations de publication
Date de publication:
01 01 2023
01 01 2023
Historique:
pmc-release:
01
01
2024
pubmed:
8
10
2022
medline:
4
1
2023
entrez:
7
10
2022
Statut:
ppublish
Résumé
Traumatic injury is the leading cause of death in children and adolescents. Hemorrhagic shock remains a common and preventable cause of death in the pediatric trauma patients. A paucity of high-quality evidence is available to guide specific aspects of hemorrhage control in this population. We sought to identify high-priority research topics for the care of pediatric trauma patients in hemorrhagic shock. A panel of 16 consensus multidisciplinary committee members from the Pediatric Traumatic Hemorrhagic Shock Consensus Conference developed research priorities for addressing knowledge gaps in the care of injured children and adolescents in hemorrhagic shock. These ideas were informed by a systematic review of topics in this area and a discussion of these areas in the consensus conference. Research priorities were synthesized along themes and prioritized by anonymous voting. Eleven research priorities that warrant additional investigation were identified by the consensus committee. Areas of proposed study included well-designed clinical trials and evaluations, including increasing the speed and accuracy of identifying and treating hemorrhagic shock, defining the role of whole blood and tranexamic acid use, and assessment of the utility and appropriate use of viscoelastic techniques during early resuscitation. The committee recommended the need to standardize essential definitions, data elements, and data collection to facilitate research in this area. Research gaps remain in many areas related to the care of hemorrhagic shock after pediatric injury. Addressing these gaps is needed to develop improved evidence-based recommendations for the care of pediatric trauma patients in hemorrhagic shock.
Sections du résumé
BACKGROUND
Traumatic injury is the leading cause of death in children and adolescents. Hemorrhagic shock remains a common and preventable cause of death in the pediatric trauma patients. A paucity of high-quality evidence is available to guide specific aspects of hemorrhage control in this population. We sought to identify high-priority research topics for the care of pediatric trauma patients in hemorrhagic shock.
METHODS
A panel of 16 consensus multidisciplinary committee members from the Pediatric Traumatic Hemorrhagic Shock Consensus Conference developed research priorities for addressing knowledge gaps in the care of injured children and adolescents in hemorrhagic shock. These ideas were informed by a systematic review of topics in this area and a discussion of these areas in the consensus conference. Research priorities were synthesized along themes and prioritized by anonymous voting.
RESULTS
Eleven research priorities that warrant additional investigation were identified by the consensus committee. Areas of proposed study included well-designed clinical trials and evaluations, including increasing the speed and accuracy of identifying and treating hemorrhagic shock, defining the role of whole blood and tranexamic acid use, and assessment of the utility and appropriate use of viscoelastic techniques during early resuscitation. The committee recommended the need to standardize essential definitions, data elements, and data collection to facilitate research in this area.
CONCLUSION
Research gaps remain in many areas related to the care of hemorrhagic shock after pediatric injury. Addressing these gaps is needed to develop improved evidence-based recommendations for the care of pediatric trauma patients in hemorrhagic shock.
Identifiants
pubmed: 36203242
doi: 10.1097/TA.0000000000003802
pii: 01586154-202301001-00003
pmc: PMC9805504
mid: NIHMS1840510
doi:
Types de publication
Systematic Review
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
S11-S18Subventions
Organisme : NICHD NIH HHS
ID : R13 HD102128
Pays : United States
Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Références
Cunningham RM, Walton MA, Carter PM. The major causes of death in children and adolescents in the United States. N Engl J Med . 2018;379(25):2468–2475.
Heron M. Deaths: leading causes for 2017. Natl Vital Stat Rep . 2019;68(6):1–77.
West BA, Rudd RA, Sauber-Schatz EK, Ballesteros MF. Unintentional injury deaths in children and youth, 2010–2019. J Safety Res . 2021;78:322–330.
Russell R, Esparaz JR, Beckwith MA, Abraham PJ, Bembea MM, et al. Pediatric Trauma Hemorrhagic Shock Consensus Conference Recommendations. J Trauma Acute Care Surg . 2022. doi: 10.1097/TA.0000000000003805. Online ahead of print.
doi: 10.1097/TA.0000000000003805
Falcone RA Jr., Haas L, King E, Moody S, Crow J, Moss A, et al. A multicenter prospective analysis of pediatric trauma activation criteria routinely used in addition to the six criteria of the American College of Surgeons. J Trauma Acute Care Surg . 2012;73(2):377–384; discussion 84.
Meyer DE, Vincent LE, Fox EE, O’Keeffe T, Inaba K, Bulger E, et al. Every minute counts: Time to delivery of initial massive transfusion cooler and its impact on mortality. J Trauma Acute Care Surg . 2017;83(1):19–24.
Powell EK, Hinckley WR, Gottula A, Hart KW, Lindsell CJ, McMullan JT. Shorter times to packed red blood cell transfusion are associated with decreased risk of death in traumatically injured patients. J Trauma Acute Care Surg . 2016;81(3):458–462.
Cannon CM, Braxton CC, Kling-Smith M, Mahnken JD, Carlton E, Moncure M. Utility of the shock index in predicting mortality in traumatically injured patients. J Trauma . 2009;67(6):1426–1430.
Polites SF, Moody S, Williams RF, Kayton ML, Alberto EC, Burd RS, et al. Timing and volume of crystalloid and blood products in pediatric trauma: an Eastern Association for the Surgery of Trauma multicenter prospective observational study. J Trauma Acute Care Surg . 2020;89(1):36–42.
Strutt J, Flood A, Kharbanda AB. Shock index as a predictor of morbidity and mortality in pediatric trauma patients. Pediatr Emerg Care . 2019;35(2):132–137.
Alberto EC, McKenna E, Amberson MJ, Tashiro J, Donnelly K, Thenappan AA, et al. Metrics of shock in pediatric trauma patients: a systematic search and review. Injury . 2021;52(10):3166–3172.
Reppucci ML, Acker SN, Cooper E, Meier M, Stevens J, Phillips R, et al. Improved identification of severely injured pediatric trauma patients using reverse shock index multiplied by Glasgow Coma Scale. J Trauma Acute Care Surg . 2022;92(1):69–73.
Mackenzie D, Briatico D, Livingston MH, Beshay T, Robinson T, Farrokhyar F, et al. Elevated international normalized ratio is correlated with large volume transfusion in pediatric trauma patients. J Pediatr Surg . 2022;57(5):903–907.
Phillips R, Acker SN, Shahi N, Meier M, Leopold D, Recicar J, et al. The ABC-D score improves the sensitivity in predicting need for massive transfusion in pediatric trauma patients. J Pediatr Surg . 2020;55(2):331–334.
Whittaker B, Christiaans SC, Altice JL, Chen MK, Bartolucci AA, Morgan CJ, et al. Early coagulopathy is an independent predictor of mortality in children after severe trauma. Shock . 2013;39(5):421–426.
Leeper CM, Kutcher M, Nasr I, McKenna C, Billiar T, Neal M, et al. Acute traumatic coagulopathy in a critically injured pediatric population: definition, trend over time, and outcomes. J Trauma Acute Care Surg . 2016;81(1):34–41.
Christiaans SC, Duhachek-Stapelman AL, Russell RT, Lisco SJ, Kerby JD, Pittet JF. Coagulopathy after severe pediatric trauma. Shock . 2014;41(6):476–490.
Nair A, Flori H, Cohen MJ. Characterization of organ dysfunction and mortality in pediatric patients with trauma with acute traumatic coagulopathy. Trauma Surg Acute Care Open . 2020;5(1):e000382.
Russell RT, Christiaans SC, Nice TR, Banks M, Mortellaro VE, Morgan C, et al. Histone-complexed DNA fragments levels are associated with coagulopathy, endothelial cell damage, and increased mortality after severe pediatric trauma. Shock . 2018;49(1):44–52.
Russell RT, McDaniel JK, Cao W, Shroyer M, Wagener BM, Zheng XL, et al. Low plasma ADAMTS13 activity is associated with coagulopathy, endothelial cell damage and mortality after severe paediatric trauma. Thromb Haemost . 2018;118(4):676–687.
Richter RP, Russell RT, Hu PJ, Uhlich RM, Swain TA, Kerby JD, et al. Plasma angiopoietin-2/-1 ratio is elevated and angiopoietin-2 levels correlate with plasma syndecan-1 following pediatric trauma. Shock . 2019;52(3):340–346.
Moore HB, Moore EE, Gonzalez E, Chapman MP, Chin TL, Silliman CC, et al. Hyperfibrinolysis, physiologic fibrinolysis, and fibrinolysis shutdown: the spectrum of postinjury fibrinolysis and relevance to antifibrinolytic therapy. J Trauma Acute Care Surg . 2014;77(6):811–817; discussion 817.
Roberts DJ, Kalkwarf KJ, Moore HB, Cohen MJ, Fox EE, Wade CE, et al. Time course and outcomes associated with transient versus persistent fibrinolytic phenotypes after injury: a nested, prospective, multicenter cohort study. J Trauma Acute Care Surg . 2019;86(2):206–213.
Moore HB, Moore EE, Liras IN, Gonzalez E, Harvin JA, Holcomb JB, et al. Acute fibrinolysis shutdown after injury occurs frequently and increases mortality: a multicenter evaluation of 2,540 severely injured patients. J Am Coll Surg . 2016;222(4):347–355.
Moore HB, Moore EE, Huebner BR, Dzieciatkowska M, Stettler GR, Nunns GR, et al. Fibrinolysis shutdown is associated with a fivefold increase in mortality in trauma patients lacking hypersensitivity to tissue plasminogen activator. J Trauma Acute Care Surg . 2017;83(6):1014–1022.
Liras IN, Cotton BA, Cardenas JC, Harting MT. Prevalence and impact of admission hyperfibrinolysis in severely injured pediatric trauma patients. Surgery . 2015;158(3):812–818.
Leeper CM, Neal MD, McKenna C, Sperry JL, Gaines BA. Abnormalities in fibrinolysis at the time of admission are associated with deep vein thrombosis, mortality, and disability in a pediatric trauma population. J Trauma Acute Care Surg . 2017;82(1):27–34.
Andrew M, Paes B, Johnston M. Development of the hemostatic system in the neonate and young infant. Am J Pediatr Hematol Oncol . 1990;12(1):95–104.
Andrew M, Paes B, Milner R, Johnston M, Mitchell L, Tollefsen DM, et al. Development of the human coagulation system in the healthy premature infant. Blood . 1988;72(5):1651–1657.
Andrew M, Paes B, Milner R, Johnston M, Mitchell L, Tollefsen DM, et al. Development of the human coagulation system in the full-term infant. Blood . 1987;70(1):165–172.
Andrew M, Vegh P, Johnston M, Bowker J, Ofosu F, Mitchell L. Maturation of the hemostatic system during childhood. Blood . 1992;80(8):1998–2005.
Muszynski JA, Nofziger R, Greathouse K, Nateri J, Hanson-Huber L, Steele L, et al. Innate immune function predicts the development of nosocomial infection in critically injured children. Shock . 2014;42(4):313–321.
Acker SN, Partrick DA, Ross JT, Nadlonek NA, Bronsert M, Bensard DD. Blood component transfusion increases the risk of death in children with traumatic brain injury. J Trauma Acute Care Surg . 2014;76(4):1082–1087; discussion 1087–8.
Bochicchio GV, Napolitano L, Joshi M, Bochicchio K, Shih D, Meyer W, et al. Blood product transfusion and ventilator-associated pneumonia in trauma patients. Surg Infect (Larchmt) . 2008;9(4):415–422.
Ladhani HA, Ho VP, Charbonnet CC, Sperry JL, Guyette FX, Brown JB, et al. Dose-dependent association between blood transfusion and nosocomial infections in trauma patients: a secondary analysis of patients from the PAMPer trial. J Trauma Acute Care Surg . 2021;91(2):272–278.
Shah S, Spinella PC, Muszynski JA. Immunologic effects of trauma and transfusion. J Trauma Acute Care Surg . 2017;82(6S Suppl 1):S50–S56.
Muszynski JA, Spinella PC, Cholette JM, Acker JP, Hall MW, Juffermans NP, et al. Transfusion-related immunomodulation: review of the literature and implications for pediatric critical illness. Transfusion . 2017;57(1):195–206.
Leonard JC, Josephson CD, Luther JF, Wisniewski SR, Allen C, Chiusolo F, et al. Life-threatening bleeding in children: a prospective observational study. Crit Care Med . 2021;49(11):1943–1954.
Shroyer MC, Griffin RL, Mortellaro VE, Russell RT. Massive transfusion in pediatric trauma: analysis of the National Trauma Databank. J Surg Res . 2017;208:166–172.
Williams J, Merutka N, Meyer D, Bai Y, Prater S, Cabrera R, et al. Safety profile and impact of low-titer group O whole blood for emergency use in trauma. J Trauma Acute Care Surg . 2020;88(1):87–93.
Shea SM, Staudt AM, Thomas KA, Schuerer D, Mielke JE, Folkerts D, et al. The use of low-titer group O whole blood is independently associated with improved survival compared to component therapy in adults with severe traumatic hemorrhage. Transfusion . 2020;60(Suppl 3):S2–S9.
Brill JB, Tang B, Hatton G, Mueck KM, McCoy CC, Kao LS, et al. Impact of incorporating whole blood into hemorrhagic shock resuscitation: analysis of 1,377 consecutive trauma patients receiving emergency-release uncrossmatched blood products. J Am Coll Surg . 2022;234(4):408–418.
Gurney JM, Staudt AM, Del Junco DJ, Shackelford SA, Mann-Salinas EA, Cap AP, et al. Whole blood at the tip of the spear: a retrospective cohort analysis of warm fresh whole blood resuscitation versus component therapy in severely injured combat casualties. Surgery . 2022;171(2):518–525.
Leeper CM, Yazer MH, Cladis FP, Saladino R, Triulzi DJ, Gaines BA. Use of uncrossmatched cold-stored whole blood in injured children with hemorrhagic shock. JAMA Pediatr . 2018;172(5):491–492.
Gaines BA, Yazer MH, Triulzi DJ, Sperry JL, Neal MD, Billiar TR, et al. Low titer group O whole blood in injured children requiring massive transfusion. Ann Surg . 2021.
Leeper CM, Yazer MH, Triulzi DJ, Neal MD, Gaines BA. Whole blood is superior to component transfusion for injured children: a propensity matched analysis. Ann Surg . 2020;272(4):590–594.
Anand T, Obaid O, Nelson A, Chehab M, Ditillo M, Hammad A, et al. Whole blood hemostatic resuscitation in pediatric trauma: a nationwide propensity-matched analysis. J Trauma Acute Care Surg . 2021;91(4):573–578.
Leeper CM, Yazer MH, Neal MD. Whole-blood resuscitation of injured patients: innovating from the past. JAMA Surg . 2020;155(8):771–772.
McCoy CC, Brenner M, Duchesne J, Roberts D, Ferrada P, Horer T, et al. Back to the future: whole blood resuscitation of the severely injured trauma patient. Shock . 2021;56(1S):9–15.
Pivalizza EG, Stephens CT, Sridhar S, Gumbert SD, Rossmann S, Bertholf MF, et al. Whole blood for resuscitation in adult civilian trauma in 2017: a narrative review. Anesth Analg . 2018;127(1):157–162.
Sethna NF, Zurakowski D, Brustowicz RM, Bacsik J, Sullivan LJ, Shapiro F. Tranexamic acid reduces intraoperative blood loss in pediatric patients undergoing scoliosis surgery. Anesthesiology . 2005;102(4):727–732.
McNicol ED, Tzortzopoulou A, Schumann R, Carr DB, Kalra A. Antifibrinolytic agents for reducing blood loss in scoliosis surgery in children. Cochrane Database Syst Rev . 2016;9(9):CD006883.
Dadure C, Sauter M, Bringuier S, Bigorre M, Raux O, Rochette A, et al. Intraoperative tranexamic acid reduces blood transfusion in children undergoing craniosynostosis surgery: a randomized double-blind study. Anesthesiology . 2011;114(4):856–861.
Goobie SM, Meier PM, Pereira LM, McGowan FX, Prescilla RP, Scharp LA, et al. Efficacy of tranexamic acid in pediatric craniosynostosis surgery: a double-blind, placebo-controlled trial. Anesthesiology . 2011;114(4):862–871.
Giordano R, Palma G, Poli V, Palumbo S, Russolillo V, Cioffi S, et al. Tranexamic acid therapy in pediatric cardiac surgery: a single-center study. Ann Thorac Surg . 2012;94(4):1302–1306.
Pasquali SK, Li JS, He X, Jacobs ML, O’Brien SM, Hall M, et al. Comparative analysis of antifibrinolytic medications in pediatric heart surgery. J Thorac Cardiovasc Surg . 2012;143(3):550–557.
Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet . 2010;376(9734):23–32.
Morrison JJ, Dubose JJ, Rasmussen TE, Midwinter MJ. Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study. Arch Surg . 2012;147(2):113–119.
Nishijima DK, Monuteaux MC, Faraoni D, Goobie SM, Lee L, Galante J, et al. Tranexamic acid use in United States children's hospitals. J Emerg Med . 2016;50(6):868–874.e1.
Horst J, Leonard JC, Vogel A, Jacobs R, Spinella PC. A survey of US and Canadian hospitals' paediatric massive transfusion protocol policies. Transfus Med . 2016;26(1):49–56.
Eckert MJ, Wertin TM, Tyner SD, Nelson DW, Izenberg S, Martin MJ. Tranexamic acid administration to pediatric trauma patients in a combat setting: the pediatric trauma and tranexamic acid study (PED-TRAX). J Trauma Acute Care Surg . 2014;77(6):852–858; discussion 8.
Hamele M, Aden JK, Borgman MA. Tranexamic acid in pediatric combat trauma requiring massive transfusions and mortality. J Trauma Acute Care Surg . 2020;89(2S Suppl 2):S242–S245.
Kornelsen E, Kuppermann N, Nishijima DK, Ren LY, Rumantir M, Gill PJ, et al. Effectiveness and safety of tranexamic acid in pediatric trauma: a systematic review and meta-analysis. Am J Emerg Med . 2022;55:103–110.
Spinella PC, Leonard JC, Gaines BA, Luther JF, Wisniewski SR, Josephson CD, et al. Use of antifibrinolytics in pediatric life-threatening hemorrhage: a prospective observational multicenter study. Crit Care Med . 2022;50(4):e382–e392.
Nishijima DK, VanBuren JM, Linakis SW, Hewes HA, Myers SR, Bobinski M, et al. Traumatic injury clinical trial evaluating tranexamic acid in children (TIC-TOC): a pilot randomized trial. Acad Emerg Med . 2022.
Dempfle CE, Borggrefe M. Point of care coagulation tests in critically ill patients. Semin Thromb Hemost . 2008;34(5):445–450.
Dempfle CE, Borggrefe M. Do we need thrombin generation assays for monitoring anticoagulation? Thromb Haemost . 2008;100(2):179–180.
Martini WZ, Cortez DS, Dubick MA, Park MS, Holcomb JB. Thrombelastography is better than PT, aPTT, and activated clotting time in detecting clinically relevant clotting abnormalities after hypothermia, hemorrhagic shock and resuscitation in pigs. J Trauma . 2008;65(3):535–543.
Park MS, Martini WZ, Dubick MA, Salinas J, Butenas S, Kheirabadi BS, et al. Thromboelastography as a better indicator of hypercoagulable state after injury than prothrombin time or activated partial thromboplastin time. J Trauma . 2009;67(2):266–275; discussion 75–6.
Kheirabadi BS, Crissey JM, Deguzman R, Holcomb JB. In vivo bleeding time and in vitro thrombelastography measurements are better indicators of dilutional hypothermic coagulopathy than prothrombin time. J Trauma . 2007;62(6):1352–1359; discussion 9–61.
Cotton BA, Faz G, Hatch QM, Radwan ZA, Podbielski J, Wade C, et al. Rapid thrombelastography delivers real-time results that predict transfusion within 1 hour of admission. J Trauma . 2011;71(2):407–414; discussion 14–7.
Jeger V, Zimmermann H, Exadaktylos AK. Can RapidTEG accelerate the search for coagulopathies in the patient with multiple injuries? J Trauma . 2009;66(4):1253–1257.
Kashuk JL, Moore EE, Sawyer M, Le T, Johnson J, Biffl WL, et al. Postinjury coagulopathy management: goal directed resuscitation via POC thrombelastography. Ann Surg . 2010;251(4):604–614.
Guth C, Vassal O, Friggeri A, Wey PF, Inaba K, Decullier E, et al. Effects of modification of trauma bleeding management: a before and after study. Anaesth Crit Care Pain Med . 2019;38(5):469–476.
Nardi G, Agostini V, Rondinelli B, Russo E, Bastianini B, Bini G, et al. Trauma-induced coagulopathy: impact of the early coagulation support protocol on blood product consumption, mortality and costs. Crit Care . 2015;19(1):83.
Prat NJ, Meyer AD, Ingalls NK, Trichereau J, DuBose JJ, Cap AP. Rotational thromboelastometry significantly optimizes transfusion practices for damage control resuscitation in combat casualties. J Trauma Acute Care Surg . 2017;83(3):373–380.
Baksaas-Aasen K, Gall LS, Stensballe J, Juffermans NP, Curry N, Maegele M, et al. Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial. Intensive Care Med . 2021;47(1):49–59.
Gonzalez E, Moore EE, Moore HB, Chapman MP, Chin TL, Ghasabyan A, et al. Goal-directed hemostatic resuscitation of trauma-induced coagulopathy: a pragmatic randomized clinical trial comparing a viscoelastic assay to conventional coagulation assays. Ann Surg . 2016;263(6):1051–1059.
Vogel AM, Radwan ZA, Cox CS Jr., Cotton BA. Admission rapid thrombelastography delivers real-time “actionable” data in pediatric trauma. J Pediatr Surg . 2013;48(6):1371–1376.
Cunningham AJ, Condron M, Schreiber MA, Azarow K, Hamilton NA, Downie K, et al. Rotational thromboelastometry predicts transfusion and disability in pediatric trauma. J Trauma Acute Care Surg . 2020;88(1):134–140.
Russell RT, Maizlin II, Vogel AM. Viscoelastic monitoring in pediatric trauma: a survey of pediatric trauma society members. J Surg Res . 2017;214:216–220.
Nellis ME, Karam O, Valentine SL, Bateman ST, Remy KE, Lacroix J, et al. Executive summary of recommendations and expert consensus for plasma and platelet transfusion practice in critically ill children: from the transfusion and anemia expertise initiative-control/avoidance of bleeding (TAXI-CAB). Pediatr Crit Care Med . 2022;23(1):34–51.
Wilkinson MD, Dumontier M, Aalbersberg IJ, Appleton G, Axton M, Baak A, et al. The FAIR Guiding Principles for scientific data management and stewardship. Sci Data . 2016;3:160018.
Ward SL, Flori HR, Bennett TD, Sapru A, Mourani PM, Thomas NJ, et al. Design and rationale for common data elements for clinical research in pediatric critical care medicine. Pediatr Crit Care Med . 2020;21(11):e1038–e1041.
Duhaime AC, Holshouser B, Hunter JV, Tong K. Common data elements for neuroimaging of traumatic brain injury: pediatric considerations. J Neurotrauma . 2012;29(4):629–633.
United States Government Accountability Office. Pediatric Trauma Centers: Availability, Outcomes, and Federal Support Related to Pediatric Trauma Care 2017 [1–34]. Available at: http://www.gao.gov/products/gao-17-334 . Accessed June 20, 2022.