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Effect of blood transfusion on outcome after major burn injury: A multicenter study*

Palmieri, Tina L. MD; Caruso, Daniel M. MD; Foster, Kevin N. MD; Cairns, Bruce A. MD; Peck, Michael D. MD, ScD; Gamelli, Richard L. MD; Mozingo, David W. MD; Kagan, Richard J. MD; Wahl, Wendy MD; Kemalyan, Nathan A. MD; Fish, Joel S. MD; Gomez, Manuel MD; Sheridan, Robert L. MD; Faucher, Lee D. MD; Latenser, Barbara A. MD; Gibran, Nicole S. MD; Klein, Robert L. MD; Solem, Lynn D. MD; Saffle, Jeffrey R. MD; Morris, Stephen E. MD; Jeng, James C. MD; Voigt, David MD; Howard, Pamela A. MD; Molitor, Fred PhD; Greenhalgh, David G. MD

doi: 10.1097/01.CCM.0000217472.97524.0E
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Objective: To delineate blood transfusion practices and outcomes in patients with major burn injury.

Context: Patients with major burn injury frequently require multiple blood transfusions; however, the effect of blood transfusion after major burn injury has had limited study.

Design: Multicenter retrospective cohort analysis.

Setting: Regional burn centers throughout the United States and Canada.

Patient Population: Patients admitted to a participating burn center from January 1 through December 31, 2002, with acute burn injuries of ≥20% total body surface area.

Outcomes Measured: Outcome measurements included mortality, number of infections, length of stay, units of blood transfused in and out of the operating room, number of operations, and anticoagulant use.

Results: A total of 21 burn centers contributed data on 666 patients; 79% of patients survived and received a mean of 14 units of packed red blood cells during their hospitalization. Mortality was related to patient age, total body surface area burn, inhalation injury, number of units of blood transfused outside the operating room, and total number of transfusions. The number of infections per patient increased with each unit of blood transfused (odds ratio, 1.13; p < .001). Patients on anticoagulation during hospitalization received more blood than patients not on anticoagulation (16.3 ± 1.5 vs. 12.3 ± 1.5, p < .001).

Conclusions: The number of transfusions received was associated with mortality and infectious episodes in patients with major burns even after factoring for indices of burn severity. The utilization of blood products in the treatment of major burn injury should be reserved for patients with a demonstrated physiologic need.

From Shriners Hospital for Children Northern California and University of California–Davis Medical Center, Sacramento, CA (TLP, DGG); Arizona Burn Center at Maricopa Medical Center, Phoenix, AZ (DMC, KNF); North Carolina Jaycee Burn Center, Chapel Hill, NC (BAC, MDP); Loyola University Medical Center, Maywood, IL (RLG); Shands Burn Center at the University of Florida, Gainesville, FL (DWM); Shriners Hospital for Children Cincinnati and The University of Cincinnati Medical Center, Cincinnati, OH (RJK); University of Michigan Health Systems, Ann Arbor, MI (WW); Oregon Burn Center, Portland, OR (NAK); Ross Tilley Burn Centre, Sunnybrook and Women’s College Health Sciences Centre, Toronto, Canada (JSF, MG); Shriners Hospital for Children Boston, Boston, MA (RLS); University of Wisconsin Burn Center, Madison, WI (LDF); University of Iowa Hospitals and Clinics, Iowa City, IA (BAL); University of Washington Burn Center, Harborview Medical Center, Seattle, WA (NSG); Clifford Boeckman Regional Burn Center, Children’s Hospital Medical Center of Akron, Akron, OH (RLK); Regions Burn Center, Regions Hospital, St. Paul, MN (LDS); University of Utah Intermountain Burn Center, Salt Lake City, UT (JRS, SEM); The Burn Center at Washington Hospital Center, Washington, DC (JCJ); St. Elizabeth Regional Burn Center, Lincoln, NE (DV); Lehigh Valley Hospital Burn Center, Allentown, PA (PAH); and ETR Associates, Sacramento, CA (FM).

Presented, in part, at the 36th Annual American Burn Association Meeting, Vancouver, British Columbia, Canada.

The authors do not have any financial interests to disclose.

© 2006 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins