Epidemiological Study on Tranexamic Acid Use in Pediatric Blunt Liver and Spleen Injuries in Japan: A Multicenter Cohort Study

PURPOSE: Blunt abdominal trauma is a leading cause of pediatric morbidity, yet tranexamic acid (TXA) use remains scarce compared to adult care. This study assessed TXA's efficacy in pediatric patients with blunt hepatic and splenic injuries. METHODS: This retrospective multicenter study in Japan (2008-2019) evaluated patients aged ≤16 years admitted for blunt hepatic or splenic injuries of grade 1 or higher, according to the American Association for the Surgery of Trauma Organ Injury Scale. We investigated clinical outcomes associated with TXA administration. FINDINGS: Among 1,406 eligible patients, 282 (20.1%) received TXA, primarily those with severe injuries. Administration occurred within 1 h of injury in 32.3%, 1-3 h in 31.2%, and after 3 h in 35.1%. No side effects were reported. However, TXA was not significantly associated with in-hospital mortality (adjusted odds ratio [aOR] 0.67, 95% confidence interval [CI] 0.16-2.79, p=0.58), red blood cell transfusion volume (coefficient -6.76, 95% CI -18.6 to 5.11, p=0.26), total transfusion volume (coefficient -3.35, 95% CI -27.8 to 21.1, p=0.79), pseudoaneurysm formation (aOR 0.75, 95% CI 0.44-1.29, p=0.30), or hospital length of stay (coefficient 3.11, 95% CI -0.12 to 6.33, p = 0.06). CONCLUSIONS: This nationwide study highlights current TXA practices in pediatric blunt abdominal trauma. No statistically significant associations between TXA administration and mortality or transfusion requirements were identified. Further adequately powered prospective studies are warranted to clarify the effectiveness of TXA in pediatric trauma.