727 - Trends in Whole Blood Use Among Pediatric Emergency Departments 2016-2024

Publication Number: 3703.727

Timothy T. Phamduy, Dayton Children's Hospital, Dayton, OH, United States; Matt hall, Children's Hospital Association, Lenexa, KS, United States; Mark Neuman, Harvard Medical School, boston, MA, United States; Jay Berry, Boston Children's Hospital, Jamaica Plain, MA, United States

Background: Whole blood (WB) contains red cells, plasma, and platelets in near-physiologic ratios and is increasingly used for trauma resuscitation due to its ability to deliver volume, oxygen, and hemostatic factors in a single product. Low-titer group O WB enables rapid transfusion regardless of blood type and may reduce mortality and simplify logistics compared to traditional component therapy. Despite growing use in adult trauma and national guideline recommendations, WB use in pediatric emergency settings remains poorly characterized.

Objective: To assess national trends in WB use among children receiving a transfusion in children's hospital emergency departments (EDs).

Design/Methods: A retrospective cohort study was performed of children age 0-to-18 years receiving WB and/or packed red blood cells (pRBC) in the ED or within one day of hospital admission between 1/1/2016 to 12/31/2024 from 49 U.S. children's hospitals contributing data to the Pediatric Health Information System (PHIS) database. We used Clinical Transaction Classification (CTC) codes to identify WB and pRBC exposures to patients. Trauma encounters were defined by trauma ICD-10-CM codes in any diagnosis field using the updated Diagnosis Grouping System (DGS).

Results: From 2016 to 2024, WB transfusion occurred in 1.0% (n=976) of the total 98,415 ED transfusion encounters, and the number of ED encounters with WB transfusion increased by 842% from n=26 to n=245 (Table). During this timeframe, non-WB encounters increased by 27% (from n=9,796 to n=12,452). As a result, WB's proportional share of annual ED transfusion encounters increased from 0.3% (26/9,822) to 1.9% (245/12,697; p< 0.001). Most WB transfusions (774/976, 79.3%) occurred between 2020 and 2024. For all transfusions, trauma was the most common diagnostic category overall (40.3% of encounters) and was more prevalent in WB vs. non-WB recipients (61.1% vs. 40.1%, p< 0.001). (Figure). WB transfusions were also common among children with hematologic (135/976, 13.8%) and cardiovascular (67/976, 6.9%) diagnoses.

Conclusion(s): While overall national use of whole blood (WB) in emergency departments of children's hospitals remains low, it has increased over the past 4 years. Trauma-related encounters accounted for the majority of WB use. Further investigation is needed to evaluate clinical outcomes, resource utilization, and patient-level predictors of WB administration.

Table. Dataset Characteristics for Transfusion Encounters in Children's Hospitals: 2016-2024


Figure
Diagnostic categories associated with transfusion encounters at children's hospitals between 2016 and 2024.