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Effects of a restrictive blood transfusion policy on outcomes in children with burn injury
Tina L Palmieri1, Terry Lee, Michael S O'Mara
1Shriners Hospital for Children Northern California, Sacramento, California 95616, USA.
Insights
A restrictive blood transfusion policy for pediatric burn patients significantly reduces blood use and costs without negatively impacting outcomes. This approach offers a safer and more economical alternative for managing critically ill children.
Area of Science:
- Pediatric critical care medicine
- Burn injury management
- Transfusion medicine
Background:
- Restrictive transfusion policies are effective in adults but their impact on critically ill children is not well-defined.
- Pediatric burn patients often require blood transfusions, necessitating an evaluation of transfusion strategies.
Purpose of the Study:
- To compare the effects of restrictive versus traditional blood transfusion policies in pediatric patients with major burn injuries.
- To assess the impact on blood utilization, costs, and patient outcomes.
Main Methods:
- Retrospective review of blood transfusions in a pediatric burn center over a 5-year period.
- Comparison of two groups: traditional (hemoglobin < 10 g/dL) and restrictive (hemoglobin < 7 g/dL) transfusion protocols.
- Analysis of demographics, ventilator use, transfusion volume, costs, and mortality.
Main Results:
- The restrictive group received significantly fewer units of blood per patient (7.2 vs 12.3 units).
- Mean blood cost per patient was substantially lower in the restrictive group ($1489 vs $2781).
- No significant differences were observed in age, burn size, sex, inhalation injury, or mortality between the groups.
Conclusions:
- A restrictive blood transfusion policy in pediatric burn patients decreases blood utilization and associated costs.
- This policy does not adversely affect patient outcomes, including mortality.
- Implementing a restrictive transfusion strategy is a cost-effective approach for managing critically ill pediatric burn patients.
Abstract:
A restrictive blood transfusion policy decreases blood utilization and improves outcomes in critically ill adults, but the impact of a restrictive blood transfusion policy in critically ill children is unclear. The study purpose was to compare the effects of a restrictive with a traditional blood transfusion policy in children with major burn injury. A retrospective review of all blood transfusions administered in a pediatric burn center during a 5-year period was conducted. Children in the traditional group (January 1, 2000, to June 30, 2002), were transfused at a hemoglobin level of less than 10 g/dl. Children in the restrictive group (January 1, 2003, to June 30, 2005, 6 months after the adoption of a restrictive protocol) were transfused at a hemoglobin level of less than 7 g/dl. Patient groups were compared for demographics, ventilator requirements, blood transfusion number, transfusion costs, and outcomes. Of the 1140 patients studied, 266 (24%) received a total of 2577 units of blood. There was no difference in age, TBSA burn, sex, inhalation injury, or mortality between groups. Patients in the traditional group received more blood than the restrictive group (12.3 +/- 1.8 vs 7.2 +/- 1.2 units/patient, P < .001). The mean cost of blood per patient was $2781 for the traditional group and $1489 for the restrictive group. A restrictive transfusion policy in children with burn injury decreases the amount of blood transfused, does not adversely impact patient outcome, and results in significant cost savings to the institution.
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