Blood transfusion
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
II
|
Supportive (Green)
|
24 hour mortality
|
Patient
|
PH-Paramedic & CCT
|
Morgan KM, Abou-Khalil E, Strotmeyer S, Richardson WM, Gaines BA, Leeper CM. Association of Prehospital Transfusion With Mortality in Pediatric Trauma. JAMA Pediatr 2023 Medline
|
III
|
Supportive (Green)
|
Safety (transfusion reaction/TRALI/Fever/Sepsis/Volume overload)
|
Patient
|
PH-Paramedic & CCT
|
Fahy AS, Thiels CA, Polites SF, Parker M, Ishitani MB, Moir CR, et al. Prehospital blood transfusions in pediatric trauma and nontrauma patients: a single-center review of safety and outcomes. Pediatr Surg Int 2017; 33(7):787-92. Medline
|
III
|
Supportive (Green)
|
24 hour survival.
|
Patient
|
PH-Paramedic & CCT
|
Moors XRJ, Bouman SJM, Peters JH, Smulders P, Oude Alink MB, Hartog DD, Stolker RJ. Prehospital Blood Transfusions in Pediatric Patients by a Helicopter Emergency Medical Service. Air Medical Journal 2018; 37(5): 321-4. Medline
|
III
|
Supportive (Green)
|
Hemodynamic status
|
Patient
|
PH-Paramedic
|
Saab MA, Jacobson E, Hanson K, Kruciak B, Miramontes D, Harper S. Prehospital whole blood administration for pediatric gastrointestinal hemorrhage: A case report. Prehosp Emerg Care June 2024; 1-6. Medline
|
Mechanical Intraosseous Insertion
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
II
|
Supportive (Green)
|
First attempt success
|
Patient
|
|
Sunde G., Heradstveit B., Vikenes B., HeltneJ. Emergency intraosseous access in a helicopter
emergency medical service: a retrospective study. Scan J Trauma, Resus and Emerg Med 2010; 18:52. Medline
|
II
|
Neutral (Yellow)
|
Placement success
|
Process
|
ED-MD
|
Banerjee S., Singhi SC., Singh S., Singh S. The IO route is a suitable alternative to IV route for fluid resuscitation in severely dehydrated children. Ind Ped 1994; 31(12):1513-20. Medline
|
III
|
Supportive (Green)
|
Overall placement success
|
Process
|
PH-Paramedic
|
Schalk R., Schweigkofler U., Lotz G., Zacharowski K., Latasch L., Byhahn C. Efficacy of the EZ-IO needle driver for out-of-hospital intraosseous access--a preliminary, observational, multicenter study. Scand J Trauma Resusc Emerg Med 2011; 19:65-7241-19-65. Medline
|
III
|
Supportive (Green)
|
Success
|
Patient
|
ED-MD
|
Voigt J., Waltzman M., Lottenberg L. Intraosseous vascular access for in-hospital emergency use: A systematic clinical review of the literature and analysis. Pediatr Emerg Care 2012; 28(2):185-199. Medline
|
Shock Prediction Tool
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
II
|
Supportive (Green)
|
Need for blood transfusion, operation, or intubation
|
Patient
|
|
Acker SN., Bredbeck B., Partrick DA., Kulungowski AM., Barnett CC., Bensard DD. Shock index, pediatric age-adjusted (SIPA) is more accurate than age-adjusted hypotension for trauma team activation. Surgery 2017; 161(3):803-7. Medline
|
II
|
Supportive (Green)
|
Factors and vital signs associated with massive transfusion
|
Patient
|
PH-Paramedic & CCT
|
CS Z, Braverman M, Goddard S, McGinity AC, Pokorny D, Cotner-Pouncy T, et al. Prehospital shock index and systolic blood pressure are highly specific for pediatric massive transfusion. J Trauma Acute Care Surg 2021; 91(4):579–83. Medline
|
II
|
Supportive (Green)
|
Need for blood transfusion
|
Process
|
ED-MD
|
Linnaus ME., Notrica DM., Langlais CS., et al. Prospective validation of the shock index pediatric-adjusted (SIPA) in blunt liver and spleen trauma: An ATOMAC+ study. J Pediatr Surg. 2017;52(2):340-344. Medline
|
II
|
Supportive (Green)
|
Predictive value
|
Process
|
ED-MD
|
Phillips R, Shahi N, Acker SN, Meier M, Shirek G, Stevens J, Recicar J, Moulton S, Bensard D. Not as simple as ABC: Tools to trigger massive transfusion in pediatric trauma. J Trauma Acute Care Surg 2022; 92(2):422–7. Medline
|
II
|
Supportive (Green)
|
Determine Shock index pediatric age-adjusted threshold value to predict mortality and / or massive transfusion
|
Patient
|
ED-Paramedic & MD
|
Stevens J, Reppucci ML, Meier M, Phillips R, Shahi N, Shirek G, et al. Pre-hospital and emergency department shock index pediatric age-adjusted (SIPA) “cut points” to identify pediatric trauma patients at risk for massive transfusion and/or mortality. J Pediatr Surg 2021. Medline
|
II
|
Neutral (Yellow)
|
SI and SIPA are simple predictive tools with sufficient accuracy to be used in the prehospital environment
|
Process
|
Other
|
Yoon SH, Shin SJ, Kim H, Roh YH. Shock index and shock index, pediatric age-adjusted as predictors of mortality in pediatric patients with trauma: A systematic review and meta-analysis. PLoS One. July 2024; 19(7):e0307367. Medline
|
Tranexamic Acid
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
II
|
Supportive (Green)
|
Mortality
|
Patient
|
Other
|
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 Dec;77(6):852-8; discussion 858. doi: 10.1097/TA.0000000000000443. PMID: 25423534. Medline
|
II
|
Supportive (Green)
|
In-hospital mortality
|
Patient
|
Other
|
Hamele M, Aden JK, Borgman MA. Tranexamic acid in pediatric combat trauma requiring massive transfusions and mortality. J Trauma Acute Care Surg. 2020 Aug;89(2S Suppl 2):S242-S245. doi: 10.1097/TA.0000000000002701. PMID: 32265388. Medline
|
II
|
Neutral (Yellow)
|
Trauma mortality
|
Patient
|
PH-Paramedic
|
Gendler S, Gelikas S, Talmy T, et al. Prehospital Tranexamic Acid Administration in Pediatric Trauma Patients: A Propensity-Matched Analysis of the Israeli Defense Forces Registry. Pediatr Crit Care Med 2023. Medline
|
II
|
Neutral (Yellow)
|
Use
|
Process
|
PH-MD & CCT
|
Gossiome A, Claustre C, Fraticelli L, Jacquet L, Bouchut JC, Javouhey E, et al. Prehospital Tranexamic Acid in Major Pediatric Trauma Within a Physician-Led Emergency Medical Services System: A Multicenter Retrospective Study. Pediatr Crit Care Med 2022. Medline
|
II
|
Neutral (Yellow)
|
Adverse effects
|
Patient
|
PH-Paramedic
|
Maeda T, Michihata N, Sasabuchi Y, Matsui H, Ohnishi Y, Miyata S, Yasunaga H. Safety of Tranexamic Acid During Pediatric Trauma: A Nationwide Database Study. Pediatr Crit Care Med. 2018 Dec;19(12):e637-e642. doi: 10.1097/PCC.0000000000001724. PMID: 30199511. Medline
|
II
|
Neutral (Yellow)
|
Survival to discharge
|
Patient
|
ED-MD
|
Thomson JM, Huynh HH, Drone HM, Jantzer JL, Tsai AK, Jancik JT. Experience in an Urban Level 1 Trauma Center With Tranexamic Acid in Pediatric Trauma: A Retrospective Chart Review. J Intensive Care Med. 2021 Apr;36(4):413-418. doi: 10.1177/0885066619890834. Epub 2020 Feb 24. PMID: 32090705. Medline
|