title: RBC transfusions in children requiring intensive care admission after traumatic injury*.
abstract: OBJECTIVE
  To describe packed RBC utilization patterns in trauma patients admitted to a PICU and study associated outcomes while controlling for severity.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  The PICU of a tertiary care children's hospital.
  
  
  METHODS
  All pediatric trauma patients admitted to Helen DeVos Children's Hospital PICU between June 2007 and July 2010, either directly from the emergency department or transferred from another institution.
  
  
  METHODS
  None.
  
  
  RESULTS
  Of 389 trauma patients, 107 patients (27.5%) transferred to the PICU were transfused with blood products. Of these transfusions, 81 were packed RBC transfusions and 26 were other blood products. Only 73 of the packed RBC transfusions had a documented time of transfusion: 17 (23.3%) were transfused prior to PICU admission, seven (9.5%) both before and after PICU, and 49 (67.1%) only after PICU admission. After adjusting for injury severity score, transfused patients had higher odds of needing mechanical ventilation (odds ratios, 9.2; 95% CI, 3.6-23.3) and higher risk of mortality (odds ratios, 8.6; 95% CI, 2.6-28.6), when compared with nontransfused patients. Mean age of packed RBC was 19.6 ± 9.3 days (mean ± SD). The impact of age of packed RBCs on mortality was examined as a categorical variable at 14, 21, and 28 days. Packed RBCs more than 28 days old (14/61 patients) were associated with longer lengths of stay (13 ± 12 vs 7 ± 6; p < 0.03), lower discharge Glasgow Coma Scale score (9 ± 6 vs 13 ± 4; p< 0.03), and more mortality (43% vs 13%; p < 0.02) when compared with blood less than 28 days old.
  
  
  CONCLUSIONS
  In pediatric trauma patients, transfusion of packed RBC and use of older RBC units are associated with higher risk of adverse outcomes independent of injury severity.
authors: 1Division of Pediatric Critical Care, Helen DeVos Children's Hospital, Grand Rapids, MI. 2Department of Statistics, Grand Valley State University, Grand Rapids, MI. 3Grand Rapids Medical Education Partners, Grand Rapids, MI. 4Department of Pathology, Spectrum Health, Grand Rapids, MI.
authors: Nabil E
authors: NE
authors: Hassan
authors: James M
authors: JM
authors: DeCou
authors: Dianne
authors: D
authors: Reischman
authors: Todd A
authors: TA
authors: Nickoles
authors: Emily
authors: E
authors: Gleason
authors: Diana L
authors: DL
authors: Ropele
authors: Dominic
authors: D
authors: Sanfilippo
authors: Alan T
authors: AT
authors: Davis
authors: David
authors: D
authors: Alters
authors: Surender
authors: S
authors: Rajasekaran
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D012121:Respiration, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000628:therapy*