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

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. 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. 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). 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.