Whole blood transfusion in pediatric trauma patients with traumatic brain injury may decrease the risk of early death.

Objective: There has been a resurgence in the use of whole blood for trauma resuscitation, however the outcomes for pediatric trauma patients with traumatic brain injury (TBI) resuscitated with whole blood are unknown. We hypothesized a lower risk of mortality and complications for pediatric trauma patients with TBI resuscitated with whole blood compared with those resuscitated exclusively with component blood therapy.

Methods: The 2020-2021 TQIP database was queried for pediatric trauma patients (≤ 17 years-old) with TBI requiring blood product resuscitation. Multivariable analysis was performed to determine associated risk of overall and early (within 24 h) mortality and overall complications.

Results: From 1740 transfused pediatric trauma patients with TBI, 195 (11%) received whole blood. The whole blood cohort received a similar amount of overall blood products and had similar overall rates of complications and death (all p > 0.05). After adjusting for age, injury severity score, and vitals on arrival, whole blood patients continued to have no difference in risk of complications and overall mortality (both p > 0.05). However, whole blood had decreased associated risk of early mortality (OR 0.49, CI 0.29-0.83, p = 0.008).

Conclusions: This study found only 11% of pediatric trauma patients with TBI received whole blood, however whole blood patients had a lower associated risk of early death compared with component blood therapy. Future prospective research is needed to validate these findings.