title: Determinants of red blood cell transfusion in pediatric trauma patients admitted to the intensive care unit.
abstract: There are no well-designed prospective studies evaluating transfusion practices in pediatric trauma. We sought to describe red blood cell (RBC) transfusion practices in trauma patients who were admitted to a pediatric intensive care unit (PICU).
  
  
  
  This study is a post-hoc analysis of a prospective, 6-month observational study in 30 PICUs. We studied a total of 580 patients aged less than 18 years who had been admitted to a PICU for more than 48 hours, including 95 who were trauma patients.
  
  
  
  Trauma patients more frequently received transfusion before PICU admission (p < 0.001), were older (p < 0.0001), and more frequently were mechanically ventilated (p = 0.05). In the PICU, trauma patients received more transfusions (55% vs. 37%; p < 0.001), although admission hemoglobin levels were similar in both groups (p = 0.86). The mean (± standard deviation) pretransfusion hemoglobin level in the PICU was 9.0 ± 2.4 g/dL for trauma patients compared with 8.3 ± 2.4 g/dL for nontrauma patients (p = 0.09). Among the trauma patients, transfusion was associated with younger age, higher Pediatric Logistic Organ Regression scores, mechanical ventilation, bleeding, and transfusion before PICU admission. Multivariate regression demonstrated that receiving an RBC transfusion before admission was strongly associated with receiving a blood transfusion in the PICU (p = 0.008).
  
  
  
  Trauma patients are at high risk for receiving an RBC transfusion both before and during their PICU stay, despite a similar transfusion threshold compared with nontrauma patients. Transfusion before PICU admission is a strong determinant, suggesting ongoing bleeding that will require re-transfusion. Further studies are needed to evaluate whether a restrictive transfusion strategy can safely be considered in these patients.
authors.affiliation: Division of Pediatric Critical Care Medicine, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Nadia
authors.initials: N
authors.lastname: Roumeliotis
authors.affiliation: Research Center of Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Thierry
authors.initials: T
authors.lastname: Ducruet
authors.affiliation: University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Scot T
authors.initials: ST
authors.lastname: Bateman
authors.affiliation: Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Adrienne G
authors.initials: AG
authors.lastname: Randolph
authors.affiliation: Division of Pediatric Critical Care Medicine, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Jacques
authors.initials: J
authors.lastname: Lacroix
authors.affiliation: Division of Pediatric Critical Care Medicine, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Emeriaud
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D017707:Erythrocyte Transfusion; D005260:Female; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D008297:Male; D011446:Prospective Studies; D014947:Wounds and Injuries / Q000628:therapy*