{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T23:15:13Z","timestamp":1773789313029,"version":"3.50.1"},"reference-count":30,"publisher":"American Academy of Pediatrics (AAP)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,10,1]]},"abstract":"\n BACKGROUND:<\/jats:title>\n Complex cranial vault reconstruction (CCVR) often requires a large-volume transfusion of blood products. We implemented a series of improvement interventions to reduce blood donor exposures (BDE) and transfusion requirements in CCVR.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n We implemented interventions over 4 epochs: (E1) reconstituted blood (1:1 ratio of donor-matched red blood cells and fresh-frozen plasma) for intraoperative transfusions, (E2) reconstituted blood plus postoperative transfusion guidelines, (E3) reconstituted blood plus intraoperative antifibrinolytics and postoperative guidelines, and (E4) fresh whole blood for intraoperative transfusion, antifibrinolytics, and postoperative guidelines. Primary outcomes, BDE, and total volume of blood products transfused are presented by using statistical process control charts, with statistical comparisons between each epoch and baseline data.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n We included 347 patients &lt;72 months old who underwent CCVR between 2008 and 2016 (E1: n = 50; E2: n = 41; E3: n = 87; and E4: n = 169). They were compared with a baseline sample group of 138 patients who were managed between 2001 and 2006. Compared with our baseline group, patients in each epoch had a significant reduction in BDE (P = .02\u2013&lt;.0001). Conversely, compared with the baseline group, we observed an increase the volume of blood products transfused in E1 (P = .004), no difference in E2 (P = .6) or E3 (P = .46), and a reduction in the volume of blood products transfused in E4 (P &lt; .0001).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n The implementation of sequential clinical improvement strategies resulted in a sustained reduction in BDE whereas only the use of whole blood resulted in a significant reduction in the total volume of blood products transfused in children undergoing CCVR.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/hpeds.2018-0027","type":"journal-article","created":{"date-parts":[[2018,10,1]],"date-time":"2018-10-01T08:25:30Z","timestamp":1538382330000},"page":"595-603","source":"Crossref","is-referenced-by-count":8,"title":["Care Standardization Reduces Blood Donor Exposures and Transfusion in Complex Cranial Vault Reconstruction"],"prefix":"10.1542","volume":"8","author":[{"given":"Wallis T.","family":"Muhly","sequence":"first","affiliation":[{"name":"Departments of Anesthesiology and Critical Care and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan M.","family":"Tan","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology and Critical Care and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grace","family":"Hsu","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology and Critical Care and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah A.","family":"Sesok-Pizzini","sequence":"additional","affiliation":[{"name":"Pathology and Laboratory Medicine, The Children\u2019s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John E.","family":"Fiadjoe","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology and Critical Care and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jesse A.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott P.","family":"Bartlett","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul A.","family":"Stricker","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology and Critical Care and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2018,10,1]]},"reference":[{"issue":"2","key":"2021120817262997900_B1","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1097\/ALN.0000000000001481","article-title":"Perioperative outcomes and management in pediatric complex cranial vault reconstruction: a multicenter study from the Pediatric Craniofacial Collaborative Group","volume":"126","author":"Stricker","year":"2017","journal-title":"Anesthesiology"},{"issue":"2","key":"2021120817262997900_B2","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1097\/SCS.0b013e31819b9429","article-title":"Predictors of blood loss in fronto-orbital advancement and remodeling","volume":"20","author":"White","year":"2009","journal-title":"J Craniofac Surg"},{"issue":"2","key":"2021120817262997900_B3","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1111\/aas.12608","article-title":"Aminocaproic acid administration is associated with reduced perioperative blood loss and transfusion in pediatric craniofacial surgery","volume":"60","author":"Hsu","year":"2016","journal-title":"Acta Anaesthesiol Scand"},{"issue":"1","key":"2021120817262997900_B4","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1097\/SCS.0b013e3182a2e23f","article-title":"Minimizing transfusions in primary cranial vault remodeling: the role of aminocaproic acid","volume":"25","author":"Oppenheimer","year":"2014","journal-title":"J Craniofac Surg"},{"issue":"2","key":"2021120817262997900_B5","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1111\/j.1460-9592.2009.03227.x","article-title":"Blood loss, replacement, and associated morbidity in infants and children undergoing craniofacial surgery","volume":"20","author":"Stricker","year":"2010","journal-title":"Paediatr Anaesth"},{"issue":"2","key":"2021120817262997900_B6","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1213\/ANE.0b013e31827008e6","article-title":"Evaluation of central venous pressure monitoring in children undergoing craniofacial reconstruction surgery","volume":"116","author":"Stricker","year":"2013","journal-title":"Anesth Analg"},{"issue":"1","key":"2021120817262997900_B7","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1111\/j.1460-9592.2010.03476.x","article-title":"Reconstituted blood reduces blood donor exposures in children undergoing craniofacial reconstruction surgery","volume":"21","author":"Stricker","year":"2011","journal-title":"Paediatr Anaesth"},{"issue":"6","key":"2021120817262997900_B8","doi-asserted-by":"crossref","first-page":"e357","DOI":"10.1097\/PCC.0b013e31825b561b","article-title":"Effect of transfusion guidelines on postoperative transfusion in children undergoing craniofacial reconstruction surgery","volume":"13","author":"Stricker","year":"2012","journal-title":"Pediatr Crit Care Med"},{"issue":"5","key":"2021120817262997900_B9","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1097\/SCS.0000000000003594","article-title":"Whole blood in pediatric craniofacial reconstruction surgery","volume":"28","author":"Thottathil","year":"2017","journal-title":"J Craniofac Surg"},{"issue":"3","key":"2021120817262997900_B10","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1111\/pan.13076","article-title":"Safety of antifibrinolytics in cranial vault reconstructive surgery: a report from the pediatric craniofacial collaborative group","volume":"27","author":"Goobie","year":"2017","journal-title":"Paediatr Anaesth"},{"issue":"3","key":"2021120817262997900_B11","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1213\/ANE.0000000000002454","article-title":"Endoscopic versus open repair for craniosynostosis in infants using propensity score matching to compare outcomes: a multicenter study from the Pediatric Craniofacial Collaborative Group","volume":"126","author":"Thompson","year":"2018","journal-title":"Anesth Analg"},{"issue":"4","key":"2021120817262997900_B12","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1097\/ALN.0b013e318210f9e3","article-title":"Intraoperative tranexamic acid reduces blood transfusion in children undergoing craniosynostosis surgery: a randomized double-blind study","volume":"114","author":"Dadure","year":"2011","journal-title":"Anesthesiology"},{"issue":"4","key":"2021120817262997900_B13","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1097\/ALN.0b013e318210fd8f","article-title":"Efficacy of tranexamic acid in pediatric craniosynostosis surgery: a double-blind, placebo-controlled trial","volume":"114","author":"Goobie","year":"2011","journal-title":"Anesthesiology"},{"issue":"3","key":"2021120817262997900_B14","first-page":"CD006883","article-title":"Antifibrinolytic agents for reducing blood loss in scoliosis surgery in children","author":"Tzortzopoulou","year":"2008","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"2021120817262997900_B15","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1053\/j.jvca.2004.01.016","article-title":"Comparison of epsilon aminocaproic acid and tranexamic acid in pediatric cardiac surgery","volume":"18","author":"Chauhan","year":"2004","journal-title":"J Cardiothorac Vasc Anesth"},{"issue":"5","key":"2021120817262997900_B16","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1093\/bja\/aes507","article-title":"Population pharmacokinetics of epsilon-aminocaproic acid in infants undergoing craniofacial reconstruction surgery","volume":"110","author":"Stricker","year":"2013","journal-title":"Br J Anaesth"},{"issue":"5","key":"2021120817262997900_B17","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1182\/blood.V77.5.930.930","article-title":"Comparison of the hemostatic effects of fresh whole blood, stored whole blood, and components after open heart surgery in children","volume":"77","author":"Manno","year":"1991","journal-title":"Blood"},{"issue":"5","key":"2021120817262997900_B18","doi-asserted-by":"crossref","first-page":"1706","DOI":"10.1016\/j.athoracsur.2014.12.070","article-title":"Reduced transfusion requirement with use of fresh whole blood in pediatric cardiac surgical procedures","volume":"99","author":"Jobes","year":"2015","journal-title":"Ann Thorac Surg"},{"issue":"1","key":"2021120817262997900_B19","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1111\/j.1537-2995.2010.02772.x","article-title":"Toward a definition of \u201cfresh\u201d whole blood: an in vitro characterization of coagulation properties in refrigerated whole blood for transfusion","volume":"51","author":"Jobes","year":"2011","journal-title":"Transfusion"},{"key":"2021120817262997900_B20","volume-title":"The Health Care Data Guide: Learning From Data for Improvement","author":"Provost","year":"2011","edition":"1st ed."},{"issue":"2","key":"2021120817262997900_B21","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.atc.2004.07.004","article-title":"Risks of blood transfusion","volume":"23","author":"Goodnough","year":"2005","journal-title":"Anesthesiol Clin North America"},{"issue":"6","key":"2021120817262997900_B22","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1097\/PRS.0000000000001783","article-title":"Assessing the impact of blood loss in cranial vault remodeling: a risk assessment model using the 2012 to 2013 Pediatric National Surgical Quality Improvement Program data sets","volume":"136","author":"Chow","year":"2015","journal-title":"Plast Reconstr Surg"},{"issue":"5","key":"2021120817262997900_B23","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1097\/ALN.0000000000000612","article-title":"Predictors of clinically significant postoperative events after open craniosynostosis surgery","volume":"122","author":"Goobie","year":"2015","journal-title":"Anesthesiology"},{"issue":"3","key":"2021120817262997900_B24","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1097\/SLA.0b013e3181c5dc2e","article-title":"Red blood cell transfusion threshold in postsurgical pediatric intensive care patients: a randomized clinical trial","volume":"251","author":"Rouette","year":"2010","journal-title":"Ann Surg"},{"issue":"10","key":"2021120817262997900_B25","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1111\/j.1460-9592.2011.03619.x","article-title":"Perioperative management of children undergoing craniofacial reconstruction surgery: a practice survey","volume":"21","author":"Stricker","year":"2011","journal-title":"Paediatr Anaesth"},{"issue":"5","key":"2021120817262997900_B26","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1055\/s-0030-1250645","article-title":"Comparison of blood-sparing efficacy of \u03b5-aminocaproic acid and tranexamic acid in newborns undergoing cardiac surgery","volume":"59","author":"Martin","year":"2011","journal-title":"Thorac Cardiovasc Surg"},{"issue":"4","key":"2021120817262997900_B27","doi-asserted-by":"crossref","first-page":"531","DOI":"10.21037\/jss.2017.08.17","article-title":"Efficacy of tranexamic acid in reducing blood loss and blood transfusion in idiopathic scoliosis: a systematic review and meta-analysis","volume":"3","author":"Alajmi","year":"2017","journal-title":"J Spine Surg"},{"issue":"5","key":"2021120817262997900_B28","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1001\/jamapediatrics.2017.5238","article-title":"Use of uncrossmatched cold-stored whole blood in injured children with hemorrhagic shock","volume":"172","author":"Leeper","year":"2018","journal-title":"JAMA Pediatr"},{"issue":"6","key":"2021120817262997900_B29","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1097\/MOH.0000000000000284","article-title":"Whole blood: back to the future","volume":"23","author":"Spinella","year":"2016","journal-title":"Curr Opin Hematol"},{"key":"2021120817262997900_B30","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1097\/SHK.0000000000000134","article-title":"Whole blood: the future of traumatic hemorrhagic shock resuscitation","volume":"41","author":"Murdock","year":"2014","journal-title":"Shock"}],"container-title":["Hospital Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article-pdf\/8\/10\/595\/814856\/hpeds_2018-0027.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article-pdf\/8\/10\/595\/814856\/hpeds_2018-0027.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,8]],"date-time":"2021-12-08T17:59:49Z","timestamp":1638986389000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article\/8\/10\/595\/26538\/Care-Standardization-Reduces-Blood-Donor-Exposures"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10,1]]},"references-count":30,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2018,10,1]]},"published-print":{"date-parts":[[2018,10,1]]}},"URL":"https:\/\/doi.org\/10.1542\/hpeds.2018-0027","relation":{},"ISSN":["2154-1663","2154-1671"],"issn-type":[{"value":"2154-1663","type":"print"},{"value":"2154-1671","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,10,1]]}}}