(346) Race and Treatments and Outcomes in Children With Life-Threatening Hemorrhage

Tuesday, February 25, 2025

11:15am – 12:15pm Eastern Time

Location: Connections Central - RST 02

First Author(s)

Gabriella Giugliano, MD (she/her/hers)

Children's Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania, USA

Co-Author(s)

CL

Christine M. Leeper, MD, MSc

Assistant Professor of Surgery and Critical Care Medicine
UPMC Presbyterian
Pittsburgh, Pennsylvania, United States
EF

Ericka Fink, MD, FCCM

Professor of Critical Care Medicine, Pediatrics, and Clinical and Translational Science
Childrens Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania, United States
LL

Liling Lu, N/a

Statistician
n/a, United States
JB

Joshua B. Brown, MD, MS

Physician
UPMC Presbyterian, United States
AH

Amy J. Houtrow, MD, PhD, MPH

Professor and Vice Chair in the Department of Physical Medicine and Rehabilitation
Children's Hospital of Pittsburgh of UPMC, United States
PS

Philip C. Spinella, MD

Professor of Surgery and Critical Care Medicine
University of Pittsburgh, United States

Introduction: Race and ethnic disparities are associated with many leading causes of pediatric mortality. Data are sparse regarding racial differences in treatment and outcomes in children with life-threatening hemorrhage.

Methods: This is a secondary analysis of a multicenter prospective observational study of massive transfusion in children (MATIC). The primary outcome is the relationship between self-reported race and 28-day mortality. Secondary endpoints are 6 hr and 24 hr mortality. Chi-square testing, univariate, weighted Cox proportional hazards regressions, and Kaplan-Meier survival plots were used for adjusted analyses.

Results: Of 449 children, the median (IQR) age was 7.3 years (1.7-14.7), 55% were male, and the median ISS was 29. In this cohort, 221 (49%) identified as non-Hispanic white, 107 (24%) as non-Hispanic Black, 43 (10%) as Hispanic, 19 (4%) as “other” race, and 59 (13%) as unknown race. Higher PRISM score, fixed and dilated pupils, age < 1 year, and medical bleeding were associated with higher risk of 28-day mortality (adjusted p< 0.05 for each). Risk factors were similar across race groups, except for bleeding etiology, which was more frequently traumatic in non-Hispanic Blacks. Patients with “unknown” race had >2-fold greater adjusted hazard ratios (HR) for mortality at 6 hr, 24 hr, and 28 days when compared to non-Hispanic whites (HR 2.4, 95% CI [1.1, 5.1]; 2.7 [1.5, 5.0]; and 2.1 [1.2, 3.7], respectively). There was a higher 28-day mortality in Hispanic patients versus non-Hispanic whites in the adjusted multivariate model (HR 1.7, 95% CI [1.0, 2.9]). Patients in the unknown race and Hispanic subgroups were least often treated with antifibrinolytics and factor concentrates (8.5% and 18.6%, respectively). After adjustment, there were no differences in the transfusion ratios of plasma:pRBC and platelet:pRBC by race.

Conclusions: Patient race may have a subtle impact in long-term survivability of life-threatening hemorrhage. Future studies are needed to define optimal management to promote equitable care and improved outcomes in the treatment of children with life-threatening hemorrhage.