Prehospital Tranexamic Acid in Major Pediatric Trauma Within a Physician-Led Emergency Medical Services System: A Multicenter Retrospective Study

Abstract

Objectives: 

Describe prehospital tranexamic acid (TXA) use and appropriateness within a major trauma pediatric population, and identify the factors associated with its use.

Design: 

Multicenter, retrospective study, 2014–2020.

Setting: 

Data were extracted from a multicenter French trauma registry including nine trauma centers within a physician-led prehospital emergency medical services (EMS) system.

Patients: 

Patients less than 18 years old were included. Those who did not receive prehospital intervention by a mobile medical team and those with missing data on TXA administration were excluded.

Interventions: 

None.

Measurements and Main Results: 

Nine-hundred thirty-four patients (median [interquartile range] age: 14 yr [9–16 yr]) were included, and 68.6% n = 639) were male. Most patients were involved in a road collision (70.2%, n = 656) and suffered a blunt trauma (96.5%; n = 900). Patients receiving TXA (36.6%; n = 342) were older (15 [13–17] vs 12 yr [6–16 yr]) compared with those who did not. Patient severity was higher in the TXA group (Injury Severity Score 14 [9–25] vs 6 [2–13]; p < 0.001). The median dosage was 16 mg/kg (13–19 mg/kg). TXA administration was found in 51.8% cases (n = 256) among patients with criteria for appropriate use. Conversely, 32.4% of patients (n = 11) with an isolated severe traumatic brain injury (TBI) also received TXA. Age (odds ratio [OR], 1.2; 95% CI, 1.1–1.2), A and B prehospital severity grade (OR, 7.1; 95% CI, 4.1–12.3 and OR, 4.5; 95% CI, 2.9–6.9 respectively), and year of inclusion (OR, 1.2; 95% CI, 1.1–1.3) were associated with prehospital TXA administration.

Conclusions: 

In our physician-led prehospital EMS system, TXA is used in a third of severely injured children despite the lack of high-level of evidence. Only half of the population with greater than or equal to one criteria for appropriate TXA use received it. Conversely, TXA was administered in a third of isolated severe TBI. Further research is warranted to clarify TXA indications and to evaluate its impact on mortality and its safety profile to oversee its prescription.