O3301: Trauma in Children: Utilization of Tranexamic Acid in Transport (TIC-TAT)

Background: Tranexamic acid (TXA) has demonstrated effectiveness in reducing blood loss and mortality in adult trauma patients. However, its efficacy and safety in pediatric trauma patients have not been extensively studied. We aimed to assess the pre-hospital utilization of TXA in pediatric trauma patients during transportation by emergency medical services (EMS).

Methods: We conducted a retrospective review of 3045 pediatric trauma patients transported by EMS before admission. Comparisons were made between patients who received pre-hospital TXA and those who did not. Clinical outcomes were evaluated including mortality, and medication related complications such as deep vein thrombosis (DVT), pulmonary embolism (PE), stroke, seizure, and intracranial venous thrombosis (IVT). Propensity score matching (1:1) was utilized.

Results: 3045 patients were included in the study, 36 received pre-hospital TXA. 35 patients who received TXA were matched to 35 patients who did not. Prior to matching patients who received TXA were more likely to be male (79% vs 62%, p=0.03), be injured via penetrating mechanism (36% vs 13%, p< 0.001), have higher Injury Severity Scores (15 vs 7, p< 0.001), and experience pre-hospital cardiac arrest (8% vs 2%, p=0.024). Additionally, they were more likely to have MTP activated (8% vs 1%, p< 0.001), receive blood transfusions (40% vs 6%, p< 0.001), require emergent surgery (18% vs 8%, p=0.03) and be admitted to the ICU (32% vs 12%, p< 0.001). They also had higher rates of in hospital mortality (16% vs 36%, p< 0.001). After controlling for age, gender, ISS and mechanism of injury, no differences were seen in rates of MTP activation, emergent surgery, ICU admission, mortality. There were no differences in the rates of medication related complications.

Conclusion: Patients who received TXA were more severely injured and required more intensive treatments than those who did not. Administration of pre-hospital TXA did not statistically increase rates of DVT, PE, stroke, seizure, or IVT. No significant differences were seen in mortality rates. Pre-hospital TXA administration is feasible, safe and does not increase complication rates.