title: Blood transfusion is an independent predictor of increased mortality in nonoperatively managed blunt hepatic and splenic injuries.
abstract: BACKGROUND
  Management strategies for blunt solid viscus injuries often include blood transfusion. However, transfusion has previously been identified as an independent predictor of mortality in unselected trauma admissions. We hypothesized that transfusion would adversely affect mortality and outcome in patients presenting with blunt hepatic and splenic injuries after controlling for injury severity and degree of shock.
  
  
  METHODS
  We retrospectively reviewed records from all adults with blunt hepatic and/or splenic injuries admitted to a Level I trauma center over a 4-year period. Demographics, physiologic variables, injury severity, and amount of blood transfused were analyzed. Univariate and multivariate analysis with logistic and linear regression were used to identify predictors of mortality and outcome.
  
  
  RESULTS
  One hundred forty-three (45%) of 316 patients presenting with blunt hepatic and/or splenic injuries received blood transfusion within the first 24 hours. Two hundred thirty patients (72.8%) were selected for nonoperative management, of whom 75 (33%) required transfusion in the first 24 hours. Transfusion was an independent predictor of mortality in all patients (odds ratio [OR], 4.75; 95% confidence interval [CI], 1.37-16.4; p = 0.014) and in those managed nonoperatively (OR, 8.45; 95% CI, 1.95-36.53; p = 0.0043) after controlling for indices of shock and injury severity. The risk of death increased with each unit of packed red blood cells transfused (OR per unit, 1.16; 95% CI, 1.10-1.24; p < 0.0001). Blood transfusion was also an independent predictor of increased hospital length of stay (coefficient, 5.45; 95% CI, 1.64-9.25; p = 0.005).
  
  
  CONCLUSIONS
  Blood transfusion is a strong independent predictor of mortality and hospital length of stay in patients with blunt liver and spleen injuries after controlling for indices of shock and injury severity. Transfusion-associated mortality risk was highest in the subset of patients managed nonoperatively. Prospective examination of transfusion practices in treatment algorithms of blunt hepatic and splenic injuries is warranted.
authors.affiliation: Section of Trauma, Burns, and Critical Care, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: William P
authors.initials: WP
authors.lastname: Robinson
authors.forename: Jeongyoun
authors.initials: J
authors.lastname: Ahn
authors.forename: Arvilla
authors.initials: A
authors.lastname: Stiffler
authors.forename: Edmund J
authors.initials: EJ
authors.lastname: Rutherford
authors.forename: Harry
authors.initials: H
authors.lastname: Hurd
authors.forename: Ben L
authors.initials: BL
authors.lastname: Zarzaur
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Baker
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Meyer
authors.forename: Preston B
authors.initials: PB
authors.lastname: Rich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001803:Blood Transfusion / Q000401:mortality / Q000706:statistics & numerical data; D002423:Cause of Death; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D008099:Liver / Q000293:injuries*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013154:Spleen / Q000293:injuries*; D013997:Time Factors; D065227:Transfusion Reaction; D014193:Trauma Centers; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000628:therapy