Jack A. Barney resident paper award: blood transfusions increase complications in moderately injured patients.
ABSTRACT Previous assessments linked transfusions in trauma to increased respiratory and infectious complications. However, these studies included patients with severe trauma, brisk hemorrhage, and shock. Thus, the potentially harmful impact of transfusion was difficult to determine.
A retrospective review of all trauma patients with an injury severity score (ISS) of 9 to 14 admitted to a Level 1 Trauma Center over a 5-year period was performed. Patients were stratified by transfusion history and injury severity.
Records of 2,332 patients were reviewed; 208 (8.9%) received at least 1 packed red blood cell transfusion. The incidence of complications was significantly higher in patients receiving transfusions (42.3% vs 9.0%; P < .001), and transfusion was a significant independent predictor of the development of a complication (odds ratio, 5.85; P < .001). Further, the association of transfusion with complications was dose-dependent. Transfusion was associated with a significantly increased hospital length of stay (10.6 vs 3.9 days; P < .0001).
Moderately injured trauma patients receiving transfusions suffered significantly more complications. Indications for transfusion in this population should be reassessed carefully.
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ABSTRACT: Historically, acute kidney injury (AKI) carried a deadly prognosis in the burn population. The aim of this study is to provide a modern description of AKI in the burn population and to develop a prediction tool for identifying patients at risk for late AKI. A large multi-institutional database, the Glue Grant's Trauma-Related Database, was used to characterize AKI in a cohort of critically ill burn patients. The authors defined AKI according to the RIFLE criteria and categorized AKI as early, late, or progressive. They then used Classification and Regression Tree (CART) analysis to create a decision tree with data obtained from the first 48 hours of admission to predict which subset of patients would develop late AKI. The accuracy of this decision tree was tested in a separate, single-institution cohort of burn patients who met the same criteria for entry into the Glue Grant study. Of the 220 total patients analyzed from the Glue Grant cohort, 49 (22.2%) developed early AKI, 39 (17.7%) developed late AKI, and 16 (7.2%) developed progressive AKI. The group with progressive AKI was statistically older, with more comorbidities and with the worst survival when compared with those with early or late AKI. Using CART analysis, a decision tree was developed with an overall accuracy of 80% for the development of late AKI for the Glue Grant dataset. The authors then tested this decision tree on a smaller dataset from our own institution to validate this tool and found it to be 73% accurate. AKI is common in severe burns with notable differences between early, late, and progressive AKI. In addition, CART analysis provided a predictive model for early identification of patients at highest risk for developing late AKI with proven clinical accuracy.Journal of burn care & research: official publication of the American Burn Association 02/2012; 33(2):242-51. · 1.54 Impact Factor
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ABSTRACT: BACKGROUND: Previous observations suggest that intraoperative blood transfusion (IBT) is a risk factor for adverse postoperative outcomes. IBT alters immune function and may predispose to systemic inflammatory response syndrome (SIRS). METHODS: Patients in the American College of Surgeons National Surgical Quality Improvement Project database were studied over a 5-year period. Logistic regression identified predictors of SIRS. Propensity matching was used to obtain a balanced set of patients with equivalent preoperative risks for IBT. RESULTS: Of 553,288 inpatients, 19,968 (3.6%) developed postoperative SIRS, and 40,378 (7.2%) received IBT. Mortality in patients with SIRS was 13-fold higher than in those without SIRS (13.5% vs 1.0%, P < .001). Multivariate analysis identified the amount of blood transfused during IBT as a significant predictor for development of SIRS (odds ratio, 2.2; P < .0001). After propensity matching, 33,507 matched patients with IBT had significantly increased risk for SIRS compared with non-SIRS matched patients (12.0% vs 6.5%, P < .001). CONCLUSIONS: There is a significant association between IBT and the development of SIRS. IBT may induce SIRS, and reductions in IBT may decrease the incidence of postoperative SIRS.American journal of surgery 02/2013; · 2.36 Impact Factor