A. Nordin1, N. Shah2, R. Devine1, R. Fabia1, R. K. Thakkar1 1Nationwide Children’s Hospital,Department Of Pediatric Surgery,Columbus, OH, USA 2Ohio State University College Of Medicine,Columbus, OH, USA
Introduction:
Blood transfusions in adult trauma patients increase the risk of nosocomial infections, and similar results have been found in adult burn patients. However, the literature regarding transfusion practices and their consequences in pediatric burns is limited. We therefore sought to determine the impact of packed red blood cell (pRBC) transfusions in pediatric patients with severe thermal injury, and hypothesized that pRBC administration would be associated with increased risk of infection and greater length of stay.
Methods:
We utilized our institutional trauma registry to identify all patients 0-18 years old admitted for burns 10% total body surface area (TBSA) or greater between 2007and 2015. Data points collected included demographics, mechanism of injury, TBSA and clinical outcomes including overall and intensive care unit (ICU) length of stay (LOS), number of operative procedures, and the number of nosocomial infections. Nosocomial infections were defined as positive cultures treated with a complete course of antibiotics. The volume of pRBC administered was also analyzed, and patients who received transfusions were compared against those who did not. Variables were analyzed using either student’s t-test or chi square analysis as appropriate.
Results:
142 patients were identified during the study period, and 15 were excluded for incomplete records. Of the remaining 127, 39 (30.7%) received pRBC transfusions and 88 (69.3%) did not require transfusion. The two groups of patients were not significantly different in terms of age, sex or weight. Mean TBSA in the transfused group was 28.7%, as compared to 14.9% among those not transfused (p < 0.001). The volume of blood transfused increased with TBSA burned. Transfused patients had significantly longer overall LOS (45.5 v 11.7 days; p < 0.001), ICU LOS (18.2 v 1.1 days; p < 0.001), and increased ventilator days (8.2 v 0.6 days; p < 0.001).The average number of operations (4.5 v 0.6; p < 0.001) and infections (3.5 v 0.2; p < 0.001) also increased relative to non-transfused patients. There were no mortalities in either group.
Conclusion:
Transfusions in pediatric burn patients are associated with adverse outcomes, including prolonged hospital and ICU LOS and increased infections. However, pRBC transfusion increased with increasing TBSA, suggesting a possible confounding factor. Our results add to existing literature on the prevalence and impact of blood transfusions in severe pediatric burns, and may have implications for the resuscitation and management of children with severe thermal injuries.