• Sami Gendler, Shaul Gelikas, Tomer Talmy, Ari M Lipsky, Guy Avital, Roy Nadler, Irina Radomislensky, Alon Ahimor, Elon Glassberg, Yael Mozer Glassberg, Ofer Almog, Mark H Yazer, and Avi Benov.
• Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel.
• Pediatr Crit Care Me. 2023 May 1; 24 (5): e236e243e236-e243.

ObjectivesTranexamic acid (TXA) administration confers a survival benefit in bleeding trauma patients; however, data regarding its use in pediatric patients are limited. This study evaluates the prehospital treatment with TXA in pediatric trauma patients treated by the Israel Defense Forces Medical Corps (IDF-MC).DesignRetrospective, cohort study using the Israel Defense Forces registry, 2011-2021.PatientsPediatric trauma patients less than 18 years old. We excluded patients pronounced dead at the scene.InterventionsNone.SettingAll cases of pediatric trauma in the registry were assessed for treatment with TXA. Propensity score matching was used to assess the association between prehospital TXA administration and mortality.Measurements And Main ResultsOverall, 911 pediatric trauma patients were treated with TXA by the IDF-MC teams; the median (interquartile) age was 10 years (5-15 yr), and 72.8% were male. Seventy patients (7.6%) received TXA, with 52 of 70 (74%) receiving a 1,000 mg dose (range 200-1,000 mg). There were no prehospital adverse events associated with the use of TXA (upper limit of 95% CI for 0/70 is 4.3%). Compared with pediatric patients who did not receive TXA, patients receiving TXA were more likely to suffer from shock (40% vs 10.7%; p < 0.001), sustain more penetrating injuries (72.9% vs 31.7%; p < 0.001), be treated with plasma or crystalloids (62.9% vs 11.4%; p < 0.001), and undergo more lifesaving interventions (24.3% vs 6.2%; p < 0.001). The propensity score matching failed to identify an association between TXA and lesser odds of mortality, although a lack of effect (or even adverse effect) could not be excluded (non-TXA: 7.1% vs TXA: 4.3%, odds ratio = 0.584; 95% CI 0.084-3.143; p = 0.718).ConclusionsAlthough prehospital TXA administration in the pediatric population is feasible with adverse event rate under 5%, more research is needed to determine the appropriate approach to pediatric hemostatic resuscitation and the role of TXA in this population.Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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