A higher plasma to red cell ratio is associated with lower 24-hour mortality in injured children receiving massive transfusion

Thesis (Master's)--University of Washington, 2020Background: Higher fresh frozen plasma (FFP) and platelet to packed red blood cell (PRBC) ratios are associated with decreased mortality in injured adults. We sought to determine if higher FFP:PRBC and platelet:PRBC ratios are associated with lower 24-hour mortality in bleeding pediatric trauma patients. Methods: This was a retrospective cohort study using the Pediatric Trauma Quality Improvement Program Database from 2014 to 2016. Injured children (≤14 years) who received massive transfusion (≥40 mL/kg total blood products in 24 hours) were included. Multivariable Poisson regression was used to determine the association between ratios of FFP:PRBC and platelet:PRBC and 24-hour mortality. Results: Of 123,836 patients, 590 underwent massive transfusion, of which 583 met inclusion criteria. Of included patients, 60% were male and the median age was 5 (IQR 2 to 10) years. Cohort 24-hour mortality was 19.7% (95% CI: 16.6 to 23.2%). The high (≥1:1) and medium (≥1:2 and <1:1) FFP:PRBC ratio groups had a lower risk of death at 24 hours (high: aRR 0.49, 95% CI: 0.27 to 0.87; medium: aRR 0.60, 95% CI: 0.39 to 0.92) compared to the low ratio group (