OA1‐AM23‐SN‐05 | Canadian Pediatric Massive Hemorrhage Protocols: A Survey of National Practice and State‐of‐the‐Art Review
Bibliographic record
Abstract
Hemorrhage is the leading cause of pediatric death in trauma and cardiac arrest during surgery. Adult studies report improved patient outcomes using massive hemorrhage protocols (MHPs). Little is known about pediatric MHP adoption in Canada. A survey of Canadian pediatric tertiary care hospitals was conducted to study MHP activations. Transfusion medicine directors provided hospital/patient demographic and MHP activation data. The authors extracted pediatric-specific MHP content from requested policy/procedure documents according to seven predefined MHP domains. Educational and audit tools were also surveyed. Only MHPs with pediatric-specific content were analyzed. Research ethics approval was waived. Eighteen hospitals (100% response rate) were surveyed: nine free-standing pediatric, two combined maternal/pediatric, and seven adult/pediatric. Only 13 had pediatric-specific MHP content (8 dedicated pediatric, 2 combined pediatric/obstetrical, 3 combined pediatric/adult). Trauma was the most common indication for activation (54%). Specific blood volume anticipated/transfused over time was the most common trigger (10/13). Transport container content was variable. First container included only RBC units in eight MHPs. Initial ratio-based blood component transfusion was recommended in 12 MHPs with a quick transition to laboratory-guided transfusion using thresholds. All MHPs used tranexamic acid. Eight sites utilized an audit tool. TABLE 1. Hospital pediatric MHP activation demographics. MHP, massive hemorrhage protocol.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.049 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.013 | 0.027 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".