PROJECT SUMMARY We propose a multi-disciplinary conference led by a group of international experts focused on the current state of the art in pediatric traumatic hemorrhagic shock that will produce consensus statements on best practice based on the current literature. Consensus statements will also be generated to establish research priorities that include optimal methods of dissemination and implementation of high quality pediatric data to allow for the efficient change of clinical practice when appropriate. Consensus statements will be developed via a highly structured process to include the Delphi Method. A panel of 21 international experts (USA, Canada, Europe, Israel) that represent trauma surgery, transfusion medicine, hematology, anesthesia, critical care, and emergency medicine will form the consensus committee. Topics to be discussed include epidemiology and outcomes, biologic consequences of hemorrhagic shock, laboratory identification of hemorrhagic shock, transfusion strategies for both prehospital and in-hospital, consequences of crystalloid and colloid resuscitation, permissive hypotension, use of intravenous and mechanical hemostatic adjuncts, developing structured multicenter data collection tools to facilitate research, and methods for consensus generation. The conference will also lead to the generation of a multidisciplinary research network focused on the resuscitation of pediatric traumatic hemorrhagic shock. A similar network of investigators does not exist. The ability to bring together international leaders in pediatric trauma resuscitation and initiate a research network will accelerate the generation of many clinical trials in this field. To encourage trainees, and prehospital care providers (military medics and civilian paramedics) to participate in this conference reduced registration and travel awards will be available.

Estimates indicate that there are 1,000 preventable traumatic deaths after injury in children per year in the US due to inadequate or delayed care, and in children with traumatic hemorrhagic shock mortality rates are 50% compared to 20-25% reported in adults. It is essential to recognize that critically ill pediatric patients may respond to resuscitation, transfusion strategies, and clinical care algorithms different than adults and will benefit from pediatric specific research to guide best practices. Trauma care is the least funded medical condition relative to its burden on society by the NIH; thus the generation of best practices, research priorities, dissemination and implementation plans for trial results and a newly formed pediatric trauma research network will be very effective at improving outcomes and reducing preventable deaths in children after traumatic injury.