Abstract
Introduction In the adult population, assessment of blood consumption (ABC) score [penetrating
mechanism, positive focused assessment sonography for trauma (FAST), systolic blood
pressure < 90, and heart rate (HR) > 120] ≥2 identifies trauma patients who require
massive transfusion (MT) with sensitivity and specificity of 75 and 86%. We hypothesized
that the adult criteria cannot be applied to children, as the vital sign cut-offs
are not age-adjusted. We aimed to determine if the use of a shock index, pediatric
age-adjusted (SIPA) would improve the discriminate ability of the ABC score in children.
Materials and Methods A retrospective review of children age 4 to 15 who received a packed red blood cell
(PRBC) transfusion during admission for trauma between 2008 and 2014 was performed.
We compared the sensitivity and specificity of ABC score ≥ 2, elevated SIPA, and age-adjusted
ABC score (ABC-S) utilizing SIPA in place of HR and BP, to determine the need for
MT.
Results A total of 50 children were included, 31 received PRBC transfusion within 6 hours
of injury, 7 children had a positive FAST, and 3 suffered penetrating trauma, all
in the early transfusion group. ABC score ≥ 2 is 29% sensitive and 100% specific at
predicting need for MT while ABC-S score ≥ 1 is 65% sensitive and 84% specific.
Conclusions Adult-based criteria for activation of MT perform poorly in the pediatric population.
The use of SIPA modestly improves the sensitivity of the ABC score in children; however,
the sensitivity and specificity of this score are still worse than when used in an
adult population. This suggests the need to develop a new score that takes into account
the low rate of penetrating trauma and positive FAST in the pediatric population.
Keywords
massive transfusion - ABC score - pediatric trauma - shock index
