title: Transfusion of stored red blood cells in critically ill trauma patients: a retrospective study.
abstract: OBJECTIVE
  The many published studies on the effects of the transfusion of stored red blood cells on clinical outcomes yielded discordant results. Therefore, we chose to study patients with severe trauma. The clinical outcomes considered included in-hospital mortality, the occurrence of sepsis, length of stay in intensive care unit and in hospital, and days of mechanical ventilation.
  
  
  METHODS
  We selected all patients with traumatic injury, who received at least 2 red cell units in the first day of admission. Patients were divided into two groups: those who had received fresh red cells only (fresh group) and those who had received at least one "old" red cell unit (old group). The red cells were considered fresh if they had been stored <14 days.
  
  
  RESULTS
  The fresh and old groups included 376 and 321 patients, respectively. Baseline demographic and clinical characteristics were comparable between the groups. However, old group received more red cell and plasma units during whole hospital stay (red cells: 11 ± 7 vs 6 ± 4, p < 0.001; plasma: 7 [0-9] vs 3 [0-6]). Among outcomes, only length of stay in intensive care unit (old vs fresh: 18 ± 9 vs 12 ± 8 days, p < 0.001) and in hospital (77 ± 35 vs 45 ± 30 days, p < 0.001) differed significantly between groups. The association remained statistically significant in a multivariate analysis including known confounding factors.
  
  
  CONCLUSIONS
  Patients with major trauma transfused with old (≥14 days) red cells had a longer length of stay in intensive care unit and in hospital, without any difference in mortality, occurence of sepsis or days of mechanical ventilation.
authors.affiliation: Department of Morphology, Surgery and Experimental Medicine, Anesthesia and Intensive Care Unit, University of Ferrara, Ferrara, Italy. savinospadaro@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Spadaro
authors.forename: R
authors.initials: R
authors.lastname: Reverberi
authors.forename: A
authors.initials: A
authors.lastname: Fogagnolo
authors.forename: R
authors.initials: R
authors.lastname: Ragazzi
authors.forename: N
authors.initials: N
authors.lastname: Napoli
authors.forename: E
authors.initials: E
authors.lastname: Marangoni
authors.forename: T
authors.initials: T
authors.lastname: Bellini
authors.forename: C A
authors.initials: CA
authors.lastname: Volta
mesh_terms: D000328:Adult; D000368:Aged; D001771:Blood Banks / Q000639:trends; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D004906:Erythrocyte Count / Q000379:methods; D017707:Erythrocyte Transfusion / Q000379:methods* / Q000401:mortality / Q000639:trends; D004912:Erythrocytes / Q000502:physiology; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units / Q000639:trends; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D000094902:Blood Banking / Q000379:methods*