title: Transfusion of red blood cells in patients with traumatic brain injuries admitted to Canadian trauma health centres: a multicentre cohort study.
abstract: Optimisation of healthcare practices in patients sustaining a traumatic brain injury is of major concern given the high incidence of death and long-term disabilities. Considering the brain's susceptibility to ischaemia, strategies to optimise oxygenation to brain are needed. While red blood cell (RBC) transfusion is one such strategy, specific RBC strategies are debated. We aimed to evaluate RBC transfusion frequency, determinants of transfusions and associated clinical outcomes.
  
  
  
  We conducted a retrospective multicentre cohort study using data from the National Trauma Registry of Canada. Patients admitted with moderate or severe traumatic brain injury to participating hospitals between April 2005 and March 2013 were eligible. Patient information on blood products, comorbidities, interventions and complications from the Discharge Abstract Database were linked to the National Trauma Registry data. Relative weights analyses evaluated the contribution of each determinant. We conducted multivariate robust Poisson regression to evaluate the association between potential determinants, mortality, complications, hospital-to-home discharge and RBC transfusion. We also used proportional hazard models to evaluate length of stay for time to discharge from ICU and hospital.
  
  
  
  Among the 7062 patients with traumatic brain injury, 1991 patients received at least one RBC transfusion during their hospital stay. Female sex, anaemia, coagulopathy, sepsis, bleeding, hypovolemic shock, other comorbid illnesses, serious extracerebral trauma injuries were all significantly associated with RBC transfusion. Serious extracerebral injuries altogether explained 61% of the observed variation in RBC transfusion. Mortality (risk ratio (RR) 1.23 (95% CI 1.13 to 1.33)), trauma complications (RR 1.38 (95% CI 1.32 to 1.44)) and discharge elsewhere than home (RR 1.88 (95% CI 1.75 to 2.04)) were increased in patients who received RBC transfusion. Discharge from ICU and hospital were also delayed in transfused patients.
  
  
  
  RBC transfusion is common in patients with traumatic brain injury and associated with unfavourable outcomes. Trauma severity is an important determinant of RBC transfusion. Prospective studies are needed to further evaluate optimal transfusion strategies in traumatic brain injury.
authors.affiliation: Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Québec, Canada.|Department of Social and Preventive Medicine, Université Laval, Québec, Québec, Canada.
authors.forename: Amélie
authors.initials: A
authors.lastname: Boutin
authors.affiliation: Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Québec, Canada.|Department of Social and Preventive Medicine, Université Laval, Québec, Québec, Canada.
authors.forename: Lynne
authors.initials: L
authors.lastname: Moore
authors.affiliation: Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Québec, Canada.|Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Québec, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Lauzier
authors.affiliation: Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Québec, Canada.|Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Québec, Canada.
authors.forename: Michaël
authors.initials: M
authors.lastname: Chassé
authors.affiliation: Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Shane
authors.initials: S
authors.lastname: English
authors.affiliation: Department of Internal Medicine, Sections of Critical Care Medicine, of Haematology and of Medical Oncology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Ryan
authors.initials: R
authors.lastname: Zarychanski
authors.affiliation: Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Lauralyn
authors.initials: L
authors.lastname: McIntyre
authors.affiliation: Department of Anesthesia, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Donald
authors.initials: D
authors.lastname: Griesdale
authors.affiliation: Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Dean A
authors.initials: DA
authors.lastname: Fergusson
authors.affiliation: Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Québec, Canada.|Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Québec, Canada.
authors.forename: Alexis F
authors.identifier: 0000-0001-5675-8791
authors.initials: AF
authors.lastname: Turgeon
mesh_terms: D015998:Abbreviated Injury Scale; D000293:Adolescent; D000328:Adult; D000368:Aged; D000740:Anemia / Q000150:complications / Q000401:mortality; D000070642:Brain Injuries, Traumatic / Q000401:mortality / Q000628:therapy*; D002170:Canada / Q000453:epidemiology; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006470:Hemorrhage / Q000150:complications / Q000401:mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications / Q000401:mortality; D017678:Sex Distribution; D012769:Shock / Q000150:complications / Q000401:mortality; D014193:Trauma Centers / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Red Blood Cell; Transfusion; Traumatic Brain Injury