title: Effect of blood transfusion on outcome after major burn injury: a multicenter study.
abstract: 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.
authors.affiliation: Shriners Hospital for Children Northern California and University of California-Davis Medical Center, Sacramento, CA, USA.
authors.forename: Tina L
authors.initials: TL
authors.lastname: Palmieri
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Caruso
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Foster
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cairns
authors.forename: Michael D
authors.initials: MD
authors.lastname: Peck
authors.forename: Richard L
authors.initials: RL
authors.lastname: Gamelli
authors.forename: David W
authors.initials: DW
authors.lastname: Mozingo
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Kagan
authors.forename: Wendy
authors.initials: W
authors.lastname: Wahl
authors.forename: Nathan A
authors.initials: NA
authors.lastname: Kemalyan
authors.forename: Joel S
authors.initials: JS
authors.lastname: Fish
authors.forename: Manuel
authors.initials: M
authors.lastname: Gomez
authors.forename: Robert L
authors.initials: RL
authors.lastname: Sheridan
authors.forename: Lee D
authors.initials: LD
authors.lastname: Faucher
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Latenser
authors.forename: Nicole S
authors.initials: NS
authors.lastname: Gibran
authors.forename: Robert L
authors.initials: RL
authors.lastname: Klein
authors.forename: Lynn D
authors.initials: LD
authors.lastname: Solem
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Saffle
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Morris
authors.forename: James C
authors.initials: JC
authors.lastname: Jeng
authors.forename: David
authors.initials: D
authors.lastname: Voigt
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Howard
authors.forename: Fred
authors.initials: F
authors.lastname: Molitor
authors.forename: David G
authors.initials: DG
authors.lastname: Greenhalgh
mesh_terms: 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
chemical_list: D000925:Anticoagulants