title: Mechanism of Injury May Influence Infection Risk from Early Blood Transfusion.
abstract: BACKGROUND
  Blood transfusion is a known risk factor for infection in trauma patients. Differences based on mechanism of injury have not been well described. We hypothesize that infection risk in trauma patients with early blood transfusion is different based on blunt or penetrating mechanism of injury.
  
  
  METHODS
  Adults admitted to the trauma intensive care unit from January 2010 through January 2015 were reviewed retrospectively. Those receiving transfusion after 24 h were excluded. Infections were defined as positive bronchoalveolar lavage, blood, urine, wound, or abdominal cultures. Logistic regression identified independent predictors of infection. Significance was considered at p ≤ 0.05.
  
  
  RESULTS
  With blunt trauma (n = 625), the transfusion rate was 36% (n = 223), with 30% (n = 186) infections. Those with an infection were more severely injured, had a higher operation rate, lower Glasgow Coma Score (GCS), longer hospital stay, and higher transfusion rate (all p < 0.001). With penetrating trauma (n = 292), the transfusion rate was 54% (n = 159), with 26% (n = 77) infections. Those with an infection were older, more severely injured, had a higher operation rate, lower GCS, longer length of stay, and higher transfusion rate (all p < 0.01). Controlling for age, injury severity score (ISS), revised trauma score (RTS), GCS, and hospital stay, transfusion was an independent predictor of infection in patients with blunt (odds ratio: 2.1, 95% confidence intervals: 1.272-3.393, p = 0.003) but not penetrating trauma.
  
  
  CONCLUSIONS
  Early blood transfusion increases infection risk in blunt but not penetrating trauma.
authors.affiliation: Ryder Trauma Center, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine , Miami, Florida.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Karcutskie
authors.affiliation: Ryder Trauma Center, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine , Miami, Florida.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Meizoso
authors.affiliation: Ryder Trauma Center, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine , Miami, Florida.
authors.forename: Juliet J
authors.initials: JJ
authors.lastname: Ray
authors.affiliation: Ryder Trauma Center, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine , Miami, Florida.
authors.forename: Davis B
authors.initials: DB
authors.lastname: Horkan
authors.affiliation: Ryder Trauma Center, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine , Miami, Florida.
authors.forename: Xiomara D
authors.initials: XD
authors.lastname: Ruiz
authors.affiliation: Ryder Trauma Center, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine , Miami, Florida.
authors.forename: Carl I
authors.initials: CI
authors.lastname: Schulman
authors.affiliation: Ryder Trauma Center, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine , Miami, Florida.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Namias
authors.affiliation: Ryder Trauma Center, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine , Miami, Florida.
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Proctor
mesh_terms: D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D065227:Transfusion Reaction; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000453:epidemiology; D014950:Wounds, Penetrating / Q000150:complications / Q000453:epidemiology; D055815:Young Adult
keywords: infection risk; mechanism of injury; transfusion; trauma