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RBC transfusions in children requiring intensive care admission after traumatic injury*
Nabil E Hassan1, James M DeCou, Dianne Reischman
11Division of Pediatric Critical Care, Helen DeVos Children's Hospital, Grand Rapids, MI. 2Department of Statistics, Grand Valley State University, Grand Rapids, MI. 3Grand Rapids Medical Education Partners, Grand Rapids, MI. 4Department of Pathology, Spectrum Health, Grand Rapids, MI.
Insights
Transfusion of packed red blood cells (RBCs) in pediatric trauma patients is linked to increased risks of mechanical ventilation and mortality. Older RBC units further elevate risks of longer hospital stays and death, irrespective of injury severity.
Area of Science:
- Pediatric Critical Care Medicine
- Transfusion Medicine
- Trauma Surgery
Background:
- Packed red blood cell (RBC) transfusions are common in critically ill patients.
- Understanding RBC utilization and its impact in pediatric trauma is crucial for optimizing patient outcomes.
- Previous studies have not fully elucidated the association between RBC transfusion and outcomes in pediatric trauma patients admitted to the Pediatric Intensive Care Unit (PICU).
Purpose of the Study:
- To investigate the utilization patterns of packed RBC transfusions in pediatric trauma patients admitted to a PICU.
- To analyze the association between packed RBC transfusion and clinical outcomes, including mechanical ventilation and mortality.
- To evaluate the impact of packed RBC age on patient outcomes, independent of injury severity.
Main Methods:
- Retrospective cohort study design.
- Inclusion of all pediatric trauma patients admitted to a tertiary care children's hospital PICU between June 2007 and July 2010.
- Statistical analysis to control for injury severity score and assess the impact of transfusion and RBC age on outcomes.
Main Results:
- 27.5% of trauma patients received blood product transfusions, with 81 instances of packed RBC transfusions.
- Transfused patients had significantly higher odds of requiring mechanical ventilation (OR, 9.2) and increased mortality risk (OR, 8.6) after adjusting for injury severity.
- Use of packed RBCs older than 28 days was associated with longer lengths of stay, lower Glasgow Coma Scale scores, and higher mortality rates compared to younger RBC units.
Conclusions:
- Packed RBC transfusion in pediatric trauma patients is independently associated with increased risks of adverse outcomes.
- The age of packed RBC units is a significant factor, with older units linked to poorer patient outcomes.
- These findings underscore the importance of judicious RBC transfusion practices and consideration of RBC age in pediatric trauma care.
Objective:
To describe packed RBC utilization patterns in trauma patients admitted to a PICU and study associated outcomes while controlling for severity.
Design:
Retrospective cohort study.
Setting:
The PICU of a tertiary care children's hospital.
Patients:
All pediatric trauma patients admitted to Helen DeVos Children's Hospital PICU between June 2007 and July 2010, either directly from the emergency department or transferred from another institution.
Interventions:
None.
Measurements And Main Results:
Of 389 trauma patients, 107 patients (27.5%) transferred to the PICU were transfused with blood products. Of these transfusions, 81 were packed RBC transfusions and 26 were other blood products. Only 73 of the packed RBC transfusions had a documented time of transfusion: 17 (23.3%) were transfused prior to PICU admission, seven (9.5%) both before and after PICU, and 49 (67.1%) only after PICU admission. After adjusting for injury severity score, transfused patients had higher odds of needing mechanical ventilation (odds ratios, 9.2; 95% CI, 3.6-23.3) and higher risk of mortality (odds ratios, 8.6; 95% CI, 2.6-28.6), when compared with nontransfused patients. Mean age of packed RBC was 19.6 ± 9.3 days (mean ± SD). The impact of age of packed RBCs on mortality was examined as a categorical variable at 14, 21, and 28 days. Packed RBCs more than 28 days old (14/61 patients) were associated with longer lengths of stay (13 ± 12 vs 7 ± 6; p < 0.03), lower discharge Glasgow Coma Scale score (9 ± 6 vs 13 ± 4; p< 0.03), and more mortality (43% vs 13%; p < 0.02) when compared with blood less than 28 days old.
Conclusions:
In pediatric trauma patients, transfusion of packed RBC and use of older RBC units are associated with higher risk of adverse outcomes independent of injury severity.
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