Survey of practices around the measurement and replacement of calcium in paediatric major trauma
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By
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Owen Hibberd
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Melanie Ranaweera
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Spyridon Karageorgos
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Kat Priddis
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Ruud G Nijman
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Andrew Tagg
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Dani Hall
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Damian Roland
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June 17, 2026
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Clinical Scorecard: Assessment of Calcium Measurement and Replacement Practices in Pediatric Major Trauma Cases
At a Glance
| Category | Detail |
|---|
| Condition | Ionised hypocalcaemia in pediatric trauma |
| Key Mechanisms | Calcium's role in clot formation, vascular tone, and cardiac contractility. |
| Target Population | Pediatric trauma patients |
| Care Setting | Emergency departments managing major trauma |
Key Highlights
- Most EDs have a pediatric major haemorrhage protocol, but 23.9% do not include calcium.
- Timing of calcium replacement is often unspecified or varies among protocols.
- Clinicians' opinions on calcium replacement differ based on patient stability.
- Significant variation exists in practices regarding calcium measurement and replacement.
- Further research is needed to establish consensus on calcium management in trauma.
Guideline-Based Recommendations
Diagnosis
- Measure ionised calcium levels in bleeding trauma patients.
Management
- Maintain normal ionised calcium levels in bleeding trauma patients.
Monitoring & Follow-up
- Consider measuring calcium prior to blood transfusion.
Risks
- Risk of undertreatment of ionised hypocalcaemia and inappropriate replacement leading to hypercalcaemia.
Patient & Prescribing Data
Pediatric patients experiencing major trauma.
Calcium replacement practices vary significantly among clinicians and protocols.
Clinical Best Practices
- Integrate calcium measurement into major haemorrhage protocols.
- Establish clear guidelines for timing and dosing of calcium replacement.
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