LAUSR

BACKGROUND Tranexamic acid (TXA) has been demonstrated to decrease mortality in adult trauma, particularly in those with massive transfusions needs sustained in combat injury. Limited data is available for the efficacy of TXA in pediatric trauma patients outside of a single Combat Support Hospital in Afghanistan. METHODS The Department of Defense Trauma Registry (DODTR) was queried for trauma patients <18 yo from Iraq and Afghanistan requiring ≥ 40 ml/kg of blood product within 24 hours of injury. Burns and fatal head traumas were excluded. Primary outcome was in-hospital mortality. Secondary outcomes were hospital, ventilator, and ICU free days as well as total blood product volume. RESULTS Amongst those pediatric patients receiving massive transfusions those who received TXA were less likely to die in hospital (8.5 vs 18.3%). Patients who received TXA and those who did not had similar hospital free days (19 vs 20), ventilator free days (27 vs 27), ICU free days (25 vs 24). Those who received TXA had higher 24 hour blood product administration (100 vs 75 ml/kg). None of our results rose to the level of statistical significance. TXA administration significantly reduced odds of death on logistic regression (OR, 0.35; 95% CI, 0.123-0.995; p = 0.0488). CONCLUSIONS Use of TXA in pediatric patients with combat trauma requiring massive transfusions trended towards a significant improvement in in-hospital mortality (p-value 0.055). This mortality benefit is similar to that seen in adult studies and less well characterized cohort in another pediatric study suggesting TXA administration confers mortality benefit in massively transfused pediatric combat trauma victims. LEVEL OF EVIDENCE (STUDY TYPE) Level IV evidence (retrospective cohort).