Sex‐based practice patterns of low titer group O whole blood administration in pediatric trauma

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INTRODUCTION: Trauma remains the leading cause of mortality and morbidity in children in the United States. Given the limited data on current low titer group O whole blood (LTOWB) use in pediatric trauma, this study was performed to describe current practices of LTOWB use among children, focusing on potential sex-based differences in LTOWB administration. METHODS: Female children <18 years who received any quantity of any blood product within 4-h of admission at a center with documented LTOWB use were compared to similarly aged males in the Trauma Quality Improvement Program (TQIP) database from 2020 to 2023. RESULTS: From 2020 to 2023, there were 16,482 children who met inclusion criteria: 4885 females and 11,597 males. Among 2136 LTOWB recipients, 79% (1682) were male. Median (IQR) composite injury severity scores were 26 (17-35) among females versus 25 (16-34, p < .001) among males. Females had a higher proportion of collision mechanisms (68% vs. 43%, p < .001) but a lower proportion of firearm mechanisms (19% vs. 44%, p < .001). Overall, after adjusting for differences, males were more likely to receive LTOWB (odds ratio [OR] 1.07, 1.05-1.08). When stratified by age and adjusted, the odds ratio for males receiving LTOWB were: <4 years (OR 0.88, 0.62-1.25), 5-9 years (1.16, 0.83-1.62), 10-14 years (1.13, 0.89-1.45), and 15-17 years (1.64, 1.40-1.93). CONCLUSIONS: Use of LTOWB was similar between male and female patients for younger children. However, among children age 15-17 years, males were more likely than females to receive LTOWB. The reasons for these differences among different age groups need to be elucidated further.

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