Paediatric trauma and hypocalcaemia: a systematic review

Background: Trauma is a leading cause of mortality and morbidity in children worldwide. While adult studies have demonstrated hypocalcaemia's association with adverse outcomes, its impact on paediatric trauma patients remains understudied. This systematic review aims to investigate current evidence into the prevalence, clinical implications and associations of hypocalcaemia in paediatric trauma.

Methods: A comprehensive literature search was conducted searching four databases, grey literature and additional sources for original studies looking at outcomes for paediatric trauma patients with ionised calcium measurements before blood product administration. Exclusion criteria comprised studies which included patients with blood product administration prior to calcium measurement, case reports, case series, reviews and papers not available in English. The review protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO): CRD42023432473. Data extraction was performed on included papers and quality assessment performed using Newcastle-Ottawa Scale.

Results: Of 779 initial studies, two studies met inclusion criteria for detailed analysis. Both retrospective cohort studies originated in Israel and collectively included 568 patients. Hypocalcaemia incidence ranged from 5.3% to 19.8%. Although trends towards increased mortality, blood transfusion requirements and prolonged hospital stays were observed in patients with hypocalcaemia, statistical significance was not consistently achieved.

Conclusion: Hypocalcaemia in paediatric trauma appears reduced in incidence compared with adult populations. Limited available studies suggest potential associations with adverse outcomes, although most were not statistically significant. Studies had small patient numbers, necessitating further prospective research to facilitate a clearer understanding. Insights from such studies can guide patient management and improve outcomes in this vulnerable population.

Prospero registration number: CRD42023432473.