Abstract
Objective. There is increasing evidence of adverse outcomes associated with blood transfusions for adult traumatic brain injury patients. However, current evidence suggests that pediatric traumatic brain injury patients may respond to blood transfusions differently on a vascular level. This study examined the influence of blood transfusions and anemia on the outcome of pediatric traumatic brain injury patients. Design. A retrospective cohort analysis of severe pediatric traumatic brain injury (TBI) patients was undertaken to investigate the association between blood transfusions and anemia on patient outcomes. Measurements and Main Results. One hundred and twenty patients with severe traumatic brain injury were identified and included in the analysis. The median Glasgow Coma Scale (GCS) was 6 and the mean hemoglobin (Hgb) on admission was 115.8 g/L. Forty-three percent of patients (43%) received at least one blood transfusion and the mean hemoglobin before transfusion was 80.1 g/L. Multivariable regression analysis revealed that anemia and the administration of packed red blood cells were not associated with adverse outcomes. Factors that were significantly associated with mortality were presence of abusive head trauma, increasing PRISM score, and low GCS after admission. Conclusion. In this single centre retrospective cohort study, there was no association found between anemia, blood transfusions, and hospital mortality in a pediatric traumatic brain injury patient population.
Highlights
Traumatic brain injury (TBI) is a leading cause of pediatric morbidity and mortality, accounting for approximately 60,000 hospitalizations and 7,400 deaths per year [1]
While the current adult literature is gaining increasing evidence that there may be an adverse effect of transfusion on TBI patients, these results may not be generalizable to pediatric patients
The likelihood ratio chi-square test was not significant (χ2 = 3.70; p = 0.594). In this retrospective cohort study of 120 pediatric patients with severe TBI admitted to our pediatric intensive care unit (PICU), it was found that hemoglobin at time of admission, administration of blood transfusions, and 7-day average hemoglobin after admission were not associated with adverse outcomes
Summary
Traumatic brain injury (TBI) is a leading cause of pediatric morbidity and mortality, accounting for approximately 60,000 hospitalizations and 7,400 deaths per year [1]. Substantial work has been done on anemia and transfusions in both adult and pediatric critically ill patients [2, 3]. Several adult studies have shown an association between anemia, blood transfusions, and poorer outcomes in patients with severe TBI [4, 5]. While the current adult literature is gaining increasing evidence that there may be an adverse effect of transfusion on TBI patients, these results may not be generalizable to pediatric patients. Significant differences exist between pediatric and adult cerebral blood flow (CBF) in both normal and traumatic-injured states [6]. Pediatric patients have increased CO2 vasoreactivity and have a CBF autoregulation system that is easier to disrupt [6]. Lacroix et al determined that pediatric patients often received leukocyte reduced blood compared to adults who did not [3]
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