Effect of blood transfusion on outcome after major burn injury: a multicenter study.
OBJECTIVE
To delineate blood transfusion practices and outcomes in patients with major burn injury.


BACKGROUND
Patients with major burn injury frequently require multiple blood transfusions; however, the effect of blood transfusion after major burn injury has had limited study.


METHODS
Multicenter retrospective cohort analysis.


METHODS
Regional burn centers throughout the United States and Canada.


METHODS
Patients admitted to a participating burn center from January 1 through December 31, 2002, with acute burn injuries of >or=20% total body surface area.


METHODS
Outcome measurements included mortality, number of infections, length of stay, units of blood transfused in and out of the operating room, number of operations, and anticoagulant use.


RESULTS
A total of 21 burn centers contributed data on 666 patients; 79% of patients survived and received a mean of 14 units of packed red blood cells during their hospitalization. Mortality was related to patient age, total body surface area burn, inhalation injury, number of units of blood transfused outside the operating room, and total number of transfusions. The number of infections per patient increased with each unit of blood transfused (odds ratio, 1.13; p<.001). Patients on anticoagulation during hospitalization received more blood than patients not on anticoagulation (16.3+/-1.5 vs. 12.3+/-1.5, p<.001).


CONCLUSIONS
The number of transfusions received was associated with mortality and infectious episodes in patients with major burns even after factoring for indices of burn severity. The utilization of blood products in the treatment of major burn injury should be reserved for patients with a demonstrated physiologic need.
Palmieri
Tina L
TL
Shriners Hospital for Children Northern California and University of California-Davis Medical Center, Sacramento, CA, USA.
Caruso
Daniel M
DM
Foster
Kevin N
KN
Cairns
Bruce A
BA
Peck
Michael D
MD
Gamelli
Richard L
RL
Mozingo
David W
DW
Kagan
Richard J
RJ
Wahl
Wendy
W
Kemalyan
Nathan A
NA
Fish
Joel S
JS
Gomez
Manuel
M
Sheridan
Robert L
RL
Faucher
Lee D
LD
Latenser
Barbara A
BA
Gibran
Nicole S
NS
Klein
Robert L
RL
Solem
Lynn D
LD
Saffle
Jeffrey R
JR
Morris
Stephen E
SE
Jeng
James C
JC
Voigt
David
D
Howard
Pamela A
PA
Molitor
Fred
F
Greenhalgh
David G
DG
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D001803:Blood Transfusion; D002056:Burns / Q000401:mortality / Q000628:therapy*; D002170:Canada / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D000925:Anticoagulants