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Intraoperative transfusion practice in burned children in a university hospital over four years: a retrospective
Eva Wittenmeier1, Astor Katharina2, Irene Schmidtmann3
1Department of Anesthesiology, University Medical Centre of Johannes Gutenberg University, Langenbeckstraße 1, 55131, Mainz, Germany. wittenme@uni-mainz.de.
Insights
Pediatric burn patients received red blood cell (RBC) transfusions more liberally than German guidelines suggest. Total body surface area burned and surgery length predicted transfusion, but RBC transfusion did not impact length of stay.
Area of Science:
- Pediatric Surgery
- Transfusion Medicine
- Burn Care
Background:
- Patient blood management is crucial for pediatric patients, yet transfusion practices for pediatric burn injury patients remain understudied.
- This study evaluates red blood cell (RBC) transfusion patterns in pediatric burn patients.
Purpose of the Study:
- To assess RBC transfusion practices in pediatric burn patients.
- To identify factors predicting RBC transfusion in this population.
- To evaluate adherence to German transfusion guidelines.
Main Methods:
- Retrospective review of RBC transfusion practices in children under 8 years old with burn injuries undergoing surgery.
- Analysis of transfusion data and guideline conformity using logistic regression.
- Evaluation of factors influencing transfusion triggers and length of hospital stay.
Main Results:
- Of 138 pediatric burn patients, 31 received RBC transfusions.
- Total body surface area burned (TBSA), surgery length, and hemoglobin (Hb) levels were associated with transfusion.
- Transfusion decisions were often inconsistent with German guidelines (23% too restrictive, 74% too liberal).
Conclusions:
- TBSA, surgery duration, and Hb levels influence RBC transfusion rates in pediatric burn patients.
- RBC transfusion did not significantly affect patient age or length of stay.
- Clinical practice demonstrates a more liberal transfusion strategy for pediatric burn patients than recommended by guidelines.
Background:
Patient blood management programs should be applied to the pediatric population, but little is known about the current transfusion practice of pediatric burn injury patients. This retrospective study was performed to evaluate the practice of red blood cell (RBC) transfusion in children with burn injury, their predictive factors, and adherence to the German transfusion guideline.
Methods:
We reviewed the RBC transfusion practice of all children younger than 8 years with burn injury who were operated during a four-year period in a German university medical center. We analyzed the data associated with transfusion and guideline conformity of transfusion triggers for RBCs from the beginning to the end of hospital stay using logistic regression.
Results:
During the four-year period, 138 children (median age 21 months, minimum-maximum 9-101 months) with burn injury needed surgery, 31 children were transfused with RBCs. During their hospital stay, the median hemoglobin concentrations (Hb) of transfused and non-transfused children were 8 g/dL (6.3-11.3 g/dL) and 10.7 (7-13.8 g/dL), respectively. Total body surface area burned (TBSA) (OR = 1.17 per % TBSA, 95% CI = [1.05; 1.30], p = 0.0056), length of surgery (OR = 1.016 per minute, 95% CI = [1.003; 1.028], p = 0.0150), and Hb (OR = 0.48 per 1 g/dl in Hb, 95% CI = [0.24; 0.95], p = 0.0343) were associated with transfusion while other factors (age, gender, ASA, and catecholamines) did not show notable association. Length of stay was mainly influenced by TSBA (+ 1.38 days per %, p < 0.0001), age (+ 0.21 days per month, p = 0.0206), and administering of catecholamines (+ 14.3 days, p = 0.0118), but not by RBC transfusion. The decision to transfuse was in 23% too restrictive and in 74% too liberal according to the German guidelines.
Conclusions:
Amount of TBSA, length of surgery, and Hb influenced the RBC transfusion rate in burned children. However, age and length of stay were not affected by transfusion of RBCs. In clinical practice of burned children, physicians follow a more liberal transfusion strategy than the proposed in guidelines.
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