Tranexamic Acid Use in United States Children's Hospitals

Daniel Nishijima, Michael C. Monuteaux, David Faraoni, Susan M. Goobie, Lois Lee, Joseph M Galante, James F Holmes Jr, Nathan Kuppermann

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background The prevalence of tranexamic acid (TXA) use for trauma and other conditions in children is unknown. Objectives The objective of this study was to describe the use of TXA in United States (US) children's hospitals for children in general, and specifically for trauma. Methods We conducted a secondary analysis of a large, administrative database of 36 US children's hospitals. We included children <18 years of age who received TXA (based on pharmacy charge codes) between 2009 and 2013. Patients were grouped into the following diagnostic categories: trauma, congenital heart surgery, scoliosis surgery, craniosynostosis/craniofacial surgery, and other, based on the International Classification of Diseases, Ninth Revision principal procedure and diagnostic codes. TXA administration and dosage, in-hospital clinical variables, and diagnostic and procedure codes were documented. Results A total of 35,478 pediatric encounters with a TXA charge were included in the study cohort. The proportions of children who received TXA were similar across the years 2009 to 2013. Only 110 encounters (0.31%) were for traumatic conditions. Congenital heart surgery accounted for more than one-half of the encounters (22,863; 64%). Overall, the median estimated weight-based dose of TXA was 22.4 mg/kg (interquartile range, 7.3–84.9 mg/kg). Conclusions We identified a wide frequency of use and range of doses of TXA for several diagnostic conditions in children. The use of TXA among injured children, however, appears to be rare despite its common use and efficacy among injured adults. Additional work is needed to identify appropriate indications for TXA and provide dosage guidelines among children with a variety of conditions, including trauma.

Original languageEnglish (US)
Pages (from-to)868-874
Number of pages7
JournalJournal of Emergency Medicine
Volume50
Issue number6
DOIs
StatePublished - Jun 1 2016

Fingerprint

Tranexamic Acid
State Hospitals
Wounds and Injuries
Thoracic Surgery
Craniosynostoses
Scoliosis
International Classification of Diseases
Cohort Studies
Databases
Guidelines
Pediatrics

Keywords

  • child
  • tranexamic acid
  • wounds and injuries

ASJC Scopus subject areas

  • Medicine(all)
  • Emergency Medicine

Cite this

Tranexamic Acid Use in United States Children's Hospitals. / Nishijima, Daniel; Monuteaux, Michael C.; Faraoni, David; Goobie, Susan M.; Lee, Lois; Galante, Joseph M; Holmes Jr, James F; Kuppermann, Nathan.

In: Journal of Emergency Medicine, Vol. 50, No. 6, 01.06.2016, p. 868-874.

Research output: Contribution to journalArticle

Nishijima, Daniel ; Monuteaux, Michael C. ; Faraoni, David ; Goobie, Susan M. ; Lee, Lois ; Galante, Joseph M ; Holmes Jr, James F ; Kuppermann, Nathan. / Tranexamic Acid Use in United States Children's Hospitals. In: Journal of Emergency Medicine. 2016 ; Vol. 50, No. 6. pp. 868-874.
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abstract = "Background The prevalence of tranexamic acid (TXA) use for trauma and other conditions in children is unknown. Objectives The objective of this study was to describe the use of TXA in United States (US) children's hospitals for children in general, and specifically for trauma. Methods We conducted a secondary analysis of a large, administrative database of 36 US children's hospitals. We included children <18 years of age who received TXA (based on pharmacy charge codes) between 2009 and 2013. Patients were grouped into the following diagnostic categories: trauma, congenital heart surgery, scoliosis surgery, craniosynostosis/craniofacial surgery, and other, based on the International Classification of Diseases, Ninth Revision principal procedure and diagnostic codes. TXA administration and dosage, in-hospital clinical variables, and diagnostic and procedure codes were documented. Results A total of 35,478 pediatric encounters with a TXA charge were included in the study cohort. The proportions of children who received TXA were similar across the years 2009 to 2013. Only 110 encounters (0.31{\%}) were for traumatic conditions. Congenital heart surgery accounted for more than one-half of the encounters (22,863; 64{\%}). Overall, the median estimated weight-based dose of TXA was 22.4 mg/kg (interquartile range, 7.3–84.9 mg/kg). Conclusions We identified a wide frequency of use and range of doses of TXA for several diagnostic conditions in children. The use of TXA among injured children, however, appears to be rare despite its common use and efficacy among injured adults. Additional work is needed to identify appropriate indications for TXA and provide dosage guidelines among children with a variety of conditions, including trauma.",
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