Clearly Defining Pediatric Massive Transfusion: Cutting Through the Fog and Friction with Combat Data

Preventing death from traumatic injury in both adult and pediatric patients requires the rapid, accurate identification of those who have bled significantly or who harbor injuries with significant bleeding potential. Identifying such patients early and responding with data-driven treatment strategies represent the singular focus of numerous ongoing investigative efforts in the trauma community. Delivery of a massive transfusion MT has been used by some to identify patients at risk for death from hemorrhage.1 MT has classically been defined as the administration of a large volume of whole blood WB or packed red blood cells PRBCs over a given time period e.g., one blood volume over 24 hours.1,2 However, most definitions are based on arbitrary volumes of products transfused over different time frames and have never been validated as predictive of mortality. 3Y5 Ultimately, the principal obstacle to creating a valid definition of MT is the heterogeneity of populations studied.1,6,7 For pediatric patients, all current MT variations in the adult literature have little relevance because of differences in patient size, patient physiology, and injury demographics.8,9 The most commonly held MT definition in the field of pediatric transfusion is the administration of 50 circulating blood volume over 24 hours. However, like the adult MT definitions, this definition is arbitrary and has never been validated, leading some to question the very utility of such a measure.