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Published on: January 31, 2018
Epidemiology of Platelet Transfusions in Hospitalized Children: A Pediatric Hospital Information System Database
Emily A Lang1, Anjile An2, Sarah Finn3
1Doctoral Program.
Insights
Platelet transfusion prevalence in hospitalized children remained stable from 2010-2019. Each additional transfusion increased the risk of thrombosis, infection, and mortality, underscoring the need for careful consideration of risks and benefits.
Area of Science:
- Pediatric Hematology
- Transfusion Medicine
- Epidemiology
Background:
- Platelet transfusions are critical for managing bleeding in pediatric patients.
- Understanding transfusion epidemiology and associated complications is essential for optimizing patient care.
- Previous studies have not comprehensively evaluated trends and risks over a decade.
Purpose of the Study:
- To determine the epidemiology of platelet transfusions in hospitalized children between 2010 and 2019.
- To identify complications and associated risk factors, including morbidity and mortality.
- To inform clinical practice regarding the judicious use of platelet transfusions.
Main Methods:
- Retrospective cohort study utilizing the Pediatric Health Information System database.
- Inclusion of all pediatric hospitalizations from 2010 to 2019.
- Extraction of data on demographics, diagnoses, procedures, complications, and outcomes for transfused patients.
Main Results:
- A total of 244,464 pediatric hospitalizations (3.89%) involved platelet transfusions, with consistent prevalence over the decade.
- Transfused children were predominantly young (under 6 years) and male (55%).
- Increasing transfusion counts correlated with higher odds of thrombosis (2%), infection (3%), and mortality (7%) after adjusting for confounders.
Conclusions:
- Platelet transfusion rates in pediatric inpatients were stable from 2010-2019.
- Each additional platelet transfusion was associated with increased risks of adverse outcomes.
- Clinical decisions regarding repeated platelet transfusions require careful risk-benefit assessment.
Objectives:
To describe the epidemiology and complications of platelet transfusions among hospitalized pediatric patients during 2010 to 2019.
Methods:
We performed a retrospective cohort study of hospitalized children within the Pediatric Health Information System database. Pediatric encounters receiving at least one platelet transfusion during hospitalization from 2010 to 2019 were identified. Data regarding demographics, diagnoses, procedures required during hospitalization, complications, and outcomes were extracted for eligible encounters.
Results:
Within the Pediatric Health Information System database, 6 284 264 hospitalizations occurred from 2010 to 2019. A total of 244 464 hospitalizations required at least one platelet transfusion, yielding a prevalence of 3.89% (95% confidence interval [CI], 3.87%-3.91%). Transfusion prevalence did not change significantly across the decade (P value = .152). Two-thirds of children receiving platelet transfusions were in their first 6 years of life, and the majority identified as male (55%). Recipients most commonly had diseases of the circulatory system (21%, 52 008 of 244 979), perinatal disorders (16%, 38 054 of 244 979), or diseases of the hematologic/immune systems (15%, 37 466 of 244 979). When adjusted for age, support by extracorporeal membrane oxygenation, mechanical ventilation, surgical intervention, and diagnostic category, the odds of thrombosis, infection, and mortality increased by 2% (odds ratio [OR], 1.02; 95% CI, 1.016-1.020), 3% (OR, 1.03; 95% CI, 1.028-1.033), and 7% (OR, 1.07; 95% CI, 1.067-1.071), respectively, with each additional transfusion.
Conclusions:
The prevalence of platelet transfusions among pediatric inpatients remained consistent across the decade. Our finding that increasing numbers of transfusions may be associated with elevated morbidity and mortality is consistent with other observation and experimental studies, highlighting the need to be thoughtful in weighing risks and benefits when prescribing repeated platelet transfusions to hospitalized children.
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