Hypocalcemia (Ca++ <1.1 mmol/L) has recently been identified as a fourth component of the “lethal triad” for mortality of adult trauma patients in addition to coagulopathy, acidosis, and hypothermia. Severe hypocalcemia (Ca++ <1.0 mmol/L) is common, occurring in about a quarter to half of all severely injured adult patients. However, little is known about the prevalence and risk of blood transfusion when hypocalcemia occurs in severely injured pediatric patients. To this end, between 2012 and 2020 researchers at the Rambam Heath Care Campus in Israel retrospectively analyzed data from all severely injured children (< 18 years) admitted directly from the accident (n=673). Of the children admitted, 459 patients had Ca++ laboratory data. There were 24 patients with hypocalcemia (Ca++ <1.1 mmol/L)—with only 3 patients having severe hypocalcemia (Ca++ <1.0 mmol/L); 35 (7.5%) of these patients required a blood transfusion in the ED. Based on multivariable logistic regression, hypocalcemia (Ca++ <1.1 mmol/L) was associated with a five-fold increased odds for blood transfusion (OR = 5.44; 95% CI, 1.44 to 20.58; p=0.01), independent of injury severity score, high shock index, and lactate levels. Unlike in adult patients, hypocalcemia is rare in pediatric trauma patients. More rigorous observational and randomized-controlled trials are needed.
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