title: Transfusion Patterns in All Patients Admitted to the Intensive Care Unit and in Those Who Die in Hospital: A Descriptive Analysis.
abstract: While it is known that the use of health care resources increases at the end of life in patients admitted to the Intensive Care Unit (ICU), the allocation of blood products at the end of life has not been described. The objective of this study was to describe overall transfusion patterns in the ICU, and specifically in patients who die in hospital. We conducted a retrospective cohort study of adult patients admitted to the ICU of a university-affiliated hospital, who were discharged or died between November 1, 2006 and June 30, 2012. During the study period, 10,642 patients were admitted at least once to the ICU. Of these patients, 4079 (38.3%) received red blood cells (RBCs), plasma or platelets in the ICU. The ICU mortality rate was 28.1% and in-hospital mortality rate was 32.3%. Among 39,591 blood product units transfused over the course of the study in the ICU (18,144 RBC units, 16,920 plasma units and 4527 platelet units), 46.2% were administered to patients who later died within the same hospitalization (41.2% of RBCs, 50.4% of plasma and 50.8% of platelets). Of all blood product units (RBCs, plasma and platelets) administered in the ICU over the study period, 11% were given within the last 24 hours before death. A large proportion of blood products used in the ICU are administered to patients who ultimately succumb to their illness in hospital, and many of these blood units are given in close proximity to death.
authors.affiliation: Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada; Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Central Ontario Region, Canadian Blood Services, Toronto, Canada.
authors.forename: Nadine
authors.initials: N
authors.lastname: Shehata
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; Institute for Clinical Evaluative Sciences, Ottawa, Canada; Department of Medicine, University of Ottawa, Ottawa, Canada.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Forster
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
authors.forename: Nadine
authors.initials: N
authors.lastname: Lawrence
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; Institute for Clinical Evaluative Sciences, Ottawa, Canada.
authors.forename: Robin
authors.initials: R
authors.lastname: Ducharme
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; Department of Medicine, University of Ottawa, Ottawa, Canada; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada; Department of Surgery, University of Ottawa, Ottawa, Canada.
authors.forename: Dean A
authors.initials: DA
authors.lastname: Fergusson
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada.
authors.forename: Michaël
authors.initials: M
authors.lastname: Chassé
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
authors.forename: Deanna M
authors.initials: DM
authors.lastname: Rothwell
authors.affiliation: Department of Medicine, University of Montreal, Montreal, Canada.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Hébert
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; Department of Medicine, University of Ottawa, Ottawa, Canada.
authors.forename: Alan T
authors.initials: AT
authors.lastname: Tinmouth
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; Institute for Clinical Evaluative Sciences, Ottawa, Canada; Department of Medicine, University of Ottawa, Ottawa, Canada.
authors.forename: Kumanan
authors.initials: K
authors.lastname: Wilson
mesh_terms: D000368:Aged; D016638:Critical Illness / Q000401:mortality*; D003643:Death; D017707:Erythrocyte Transfusion / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010949:Plasma / Q000378:metabolism; D017713:Platelet Transfusion / Q000401:mortality*; D012189:Retrospective Studies