title: The Epidemiology of Transfusion-related Acute Lung Injury Varies According to the Applied Definition of Lung Injury Onset Time.
abstract: BACKGROUND
  Research that applies an unreliable definition for transfusion-related acute lung injury (TRALI) may draw false conclusions about its risk factors and biology. The effectiveness of preventive strategies may decrease as a consequence. However, the reliability of the consensus TRALI definition is unknown.
  
  
  OBJECTIVE
  To prospectively study the effect of applying two plausible definitions of acute respiratory distress syndrome onset time on TRALI epidemiology.
  
  
  METHODS
  We studied 316 adults admitted to the intensive care unit and transfused red blood cells within 24 hours of blunt trauma. We identified patients with acute respiratory distress syndrome, and defined acute respiratory distress syndrome onset time two ways: (1) the time at which the first radiographic or oxygenation criterion was met, and (2) the time both criteria were met. We categorized two corresponding groups of TRALI cases transfused in the 6 hours before acute respiratory distress syndrome onset. We used Cohen's kappa to measure agreement between the TRALI cases and implicated blood components identified by the two acute respiratory distress syndrome onset time definitions. In a nested case-control study, we examined potential risk factors for each group of TRALI cases, including demographics, injury severity, and characteristics of blood components transfused in the 6 hours before acute respiratory distress syndrome onset.
  
  
  RESULTS
  Forty-two of 113 patients with acute respiratory distress syndrome were TRALI cases per the first acute respiratory distress syndrome onset time definition and 63 per the second definition. There was slight agreement between the two groups of TRALI cases (κ = 0.16; 95% confidence interval, -0.01 to 0.33) and between the implicated blood components (κ = 0.15, 95% confidence interval, 0.11-0.20). Age, Injury Severity Score, high plasma-volume components, and transfused plasma volume were risk factors for TRALI when applying the second acute respiratory distress syndrome onset time definition but not when applying the first definition.
  
  
  CONCLUSIONS
  The epidemiology of TRALI varies when applying two plausible definitions of acute respiratory distress syndrome onset time to severely injured trauma patients. A TRALI definition that standardizes acute respiratory distress syndrome onset time might improve reliability and align efforts to understand epidemiology, biology, and prevention.
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine.
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Vande Vusse
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine.
authors.forename: Ellen
authors.initials: E
authors.lastname: Caldwell
authors.affiliation: 2 Research Institute, Puget Sound Blood Center, Seattle, Washington.
authors.forename: Edward
authors.initials: E
authors.lastname: Tran
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine.
authors.forename: Laurie
authors.initials: L
authors.lastname: Hogl
authors.affiliation: 2 Research Institute, Puget Sound Blood Center, Seattle, Washington.
authors.forename: Steven
authors.initials: S
authors.lastname: Dinwiddie
authors.affiliation: 3 Division of Hematology, and.|2 Research Institute, Puget Sound Blood Center, Seattle, Washington.
authors.forename: José A
authors.initials: JA
authors.lastname: López
authors.affiliation: 4 Department of Surgery, University of Washington, Seattle, Washington; and.
authors.forename: Ronald V
authors.initials: RV
authors.lastname: Maier
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine.|2 Research Institute, Puget Sound Blood Center, Seattle, Washington.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Watkins
mesh_terms: D055371:Acute Lung Injury / Q000175:diagnosis* / Q000209:etiology*; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D012307:Risk Factors
keywords: blood transfusion; lung injury; trauma