Aggressive red blood cell transfusion: no association with improved outcomes for victims of isolated traumatic brain injury.
BACKGROUND
Clinical studies have caused blood transfusion practices in critically ill patients to become more conservative in the last decade. However, few studies have focused on trauma patients, particularly those with severe isolated traumatic brain injury.


METHODS
We conducted a retrospective study to test the hypothesis that patients with severe brain injury would not benefit from aggressive red blood cell transfusion (RBCT). End points of the study were in-hospital mortality and morbidity (pneumonia, urinary tract infection, deep venous thrombosis, pulmonary embolus, decubitus ulcer, bacteremia, septic shock, myocardial infarction, and seizure). Included in our retrospective study were patients at two urban, level I trauma centers who were admitted with a diagnosis of isolated head injury and with a Glasgow Coma Scale (GCS) score of 8 or less. We recorded demographic, interventional, and outcome variables.


RESULTS
In 289 patients, 24 of 25 (96%) were transfused if their lowest recorded intensive care unit (ICU) hemoglobin level was 8.0 g/dl or less. In contrast, only 9/182 (5%) of these 289 patients were transfused if the hemoglobin levels were 10.0 g/dl or greater. In the remaining 82 patients with lowest ICU hemoglobin levels of 8.0-10.0 g/dl, 52% were transfused. These 82 patients (43 underwent RBCT and 39 did not) were included in our analysis.


CONCLUSIONS
The overall in-hospital mortality rate was 32%; rates were similar between the two groups (29%, non-RBCT; 35%, RBCT) (P = 0.64). Likewise, in-hospital morbidity was similar between groups. Logistic and proportional hazard regression analyses identified RBCT as one predictor of mortality.


CONCLUSIONS
Our results suggest that a restrictive transfusion practice is safe for severely head-injured patients.
George
Mark E
ME
Department of Surgery, Division of Critical Care, University of Minnesota Medical Center, Fairview, MMC 11, 420 Delaware St SE, Minneapolis, MN 55455, USA. geor0040@umn.edu
Skarda
David E
DE
Watts
Charles R
CR
Pham
Hoai D
HD
Beilman
Greg J
GJ
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000740:Anemia / Q000401:mortality / Q000628:therapy; D001930:Brain Injuries / Q000401:mortality* / Q000628:therapy*; D017707:Erythrocyte Transfusion; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015599:Trauma Severity Indices