Abstract Background The prehospital transfusion of red blood cell (RBC) concentrates represents an emerging approach in paediatric trauma management. Nevertheless, distinctive parameters for predicting the need for transfusion in children are still lacking. This study aimed to identify predictors for early in-hospital RBC transfusions that are readily available to emergency medical services (EMS) at the scene to aid in deciding whether to transfuse. Methods This study comprised a retrospective analysis of the German TraumaRegister DGU®. It included children and adolescents aged 1 to 16 years from Germany, Austria, and Switzerland over a 15-year period. Contingency tables were used to identify risk factors, which were then assessed through multivariate regression analysis. The model’s predictive capacity was evaluated using the receiver operating characteristic (ROC) curve. Results A total of 11,849 patients were included, with RBC transfusion performed in 5.9% of cases. Polytraumatised patients (adjusted odds ratio (adj. OR) 4.18 95% confidence interval 3.26–5.34) and those with penetrating injuries (adj. OR 4.32 2.96–6.30) and abdominal injuries (adj. OR 4.18 3.34–5.24) exhibited the highest risk of requiring an RBC transfusion. The need for cardiopulmonary resuscitation (adj. OR 2.46 1.84–3.28), endotracheal intubation (adj. OR 2.51 1.93–3.28), and Glasgow Coma Scale (GCS) ≤ 8 (adj. OR 2.49 1.85–3.36) were also significant, but weaker, predictors. A model based on the mentioned parameters achieved an area under the ROC curve of 0.87 0.85–0.88. Conclusion The likelihood of requiring an RBC transfusion is increased in cases of polytrauma, abdominal and penetrating trauma, patients with a GCS ≤ 8, and those requiring tracheal intubation or cardiopulmonary resuscitation. All the included parameters are straightforward to assess, making them practical for use by EMS. Therefore, the proposed risk factors can help identify patients at risk of severe haemorrhage and subsequent transfusion requirement. Clinical Trial Number: not applicable
Schneider et al. (Wed,) studied this question.