title: Blood transfusions are associated with increased risk for development of sepsis in severely burned pediatric patients.
abstract: OBJECTIVE
  To determine the risk of developing sepsis following transfusion of blood products in severely burned pediatric patients.
  
  
  METHODS
  Retrospective, cohort study.
  
  
  METHODS
  Shriners Hospital for Children and University Hospital.
  
  
  METHODS
  Severely burned pediatric patients with >30% total body surface area (TBSA) burn.
  
  
  METHODS
  None.
  
  
  RESULTS
  Two hundred seventy-seven pediatric burn patients over a period of 7 yrs (1997-2004) were included in the study, with 25 patients being septic at admission and therefore excluded. Patients were stratified according to TBSA burn and presence or absence of inhalation injury. The amounts of packed red blood cells (RBCs) and fresh frozen plasma (FFP) were recorded during hospital stay before the development of sepsis. Blood product administration was normalized for the number of surgeries and divided into two groups: high (RBCs>20/FFP>5) or low (RBCs<20/FFP<5) amount of blood products. Sepsis was diagnosed based on the criteria set by the Society of Critical Care Medicine in conjunction with positive blood culture or presence of organisms in the organs at autopsy. By stratifying the groups into low and high blood transfusion, we found that patients with >60% TBSA burn with inhalation injury have an 8% risk of developing sepsis in the low RBC group, which increases to 58% in the high RBC group (p<.05). Similar results were found for RBCs per operation, FFP, and FFP per operation (p<.05). There were no differences in age and gender between groups.
  
  
  CONCLUSIONS
  Pediatric burn suffering from a 60% TBSA burn with concomitant inhalation injury are more likely to develop sepsis if they are given high amounts of blood products, indicating an immunocompromised state following blood transfusion.
authors.affiliation: Shriners Hospitals for Children and Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Jeschke
authors.forename: David L
authors.initials: DL
authors.lastname: Chinkes
authors.forename: Celeste C
authors.initials: CC
authors.lastname: Finnerty
authors.forename: Rene
authors.initials: R
authors.lastname: Przkora
authors.forename: Clifford T
authors.initials: CT
authors.lastname: Pereira
authors.forename: David N
authors.initials: DN
authors.lastname: Herndon
mesh_terms: D002056:Burns / Q000150:complications* / Q000401:mortality / Q000601:surgery; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology* / Q000401:mortality; D065227:Transfusion Reaction