RBC transfusions in children requiring intensive care admission after traumatic injury.

Hassan NE, DeCou JM, Reischman D, et al.
Pediatr Crit Care Med 2014;15:e306-313.
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Review by : J. Lacroix
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Hassan et al. undertook a descriptive retrospective clinical research to characterise the epidemiology of red blood cell (RBC) transfusion in trauma patients admitted to the paediatric intensive care unit (PICU) at the Helen DeVos Children’s Hospital. All trauma patients admitted between June 2007 and July 2010 were considered for inclusion. Patients with massive transfusion and burned patients were excluded.

Amongst 389 retained cases of trauma, 107 (27.5%) were transfused (RBC, plasma and/or platelets); 81 (20.8%) received at least one RBC transfusion before and/or during PICU stay. After adjustment for severity of trauma using the injury severity score, children who received a RBC transfusion had higher odds of needing mechanical ventilation (OR, 9.2; 95%CI, 3.6-23.3) and of mortality (OR, 8.6; 95%CI, 2.6-28.6). Packed RBC units stored more than 28 days were associated with prolonged stay in PICU, lower Glasgow coma score at discharge and higher mortality rate (43% vs. 13%; P < 0.02) when compared to packed RBC units stored for < 28 days. This study shows that RBC transfusion adds risk independent of injury severity. Moreover, increased length of storage of RBC units may be harmful to paediatric trauma patients. – Jacques Lacroix
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