Aim - To report our experience with Paediatric Major Haemorrhage (PMH) or "Code red" trauma activations in patients <16 years.
Background – PMH is a rare, complex and potentially catastrophic event. Management of major haemorrhage has improved incrementally, from the recognition of acute traumatic coagulopathy in 2003, to CRASH-2 in 2010. Major haemorrhage research has focused on adults, data in children is extremely limited.
Method - Review of a prospectively maintained database of paediatric trauma activations between Jan 2012 and June 2017 with reference to PHM. Data collected: demographics, mechanism of injury (MOI), international injury severity score (ISS), procedures, length of stay (days) and outcome.
Results - Over 5.5 years there were 1488 paediatric trauma call activations with 18 PMH (1.2%). 14 (78%) male. Median age = 13 years (range 2 - 15). Mechanism of injury was a variety of blunt force trauma in 8 patients (44%) and penetrating wound sites in 10 (56%). Mean injury severity score was 20.6 (range 1-75). 8 (44%) patients required immediate operative intervention, overall 89% patients required acute surgical intervention. Median length of stay was 17 days (range 1-61). The overall mortality rate was 22.2% (4/18).
Since PMH protocol activations are rare (1.2% trauma activations), high risk (22.2% mortality) and occur in the context of virtually no published data, a requirement exists in the first instance, to improve data collection/sharing nationally.
This series demonstrates multiple potential mechanisms of injury that cause devastating injuries to children and the subsequent breadth of experience/skills required to manage them.
In order to parallel the incremental improvements seen in adult trauma outcomes, centres managing severely injured children must collaborate to collect, analyse and report just this sort of data. This will better inform practice and may allow us to undertake multicentre, prospective longitudinal studies or trials.