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Author Notes:

Michael Dallman, MD, University of Mississippi School of Medicine, Department of Pediatrics, Division of Pediatric Critical Care Medicine, 2500 N. State St., Jackson, MS 93216, dallman.md@gmail.com.

We thank Colleen Riley and Jingkun Zhu for their assistance in database maintenance and abstraction.

Helpful criticism was received from Carl Shanholtz, MD.

The authors declare that they have no conflicts of interest relevant to this manuscript submitted to Pediatric Critical Care Medicine.

Subjects:

Research Funding:

Supported, in part, by a Clinical Research Career Development Award from the National Institutes of Health (NIH), Bethesda, MD (5K12RR023250-03 to Dr. Netzer); and by a Midcareer Investigator Grant from the NIH (1K24AI079040-01A1 to Dr. Harris).

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Critical Care Medicine
  • Pediatrics
  • General & Internal Medicine
  • blood component transfusion
  • erythrocyte transfusion
  • evidence-based practice
  • pediatrics
  • pediatric intensive care units
  • physicians practice patterns
  • BLOOD-CELL TRANSFUSIONS
  • MULTIPLE ORGAN DYSFUNCTION
  • CRITICALLY-ILL
  • CARDIAC-SURGERY
  • CARE-UNIT
  • CHILDREN
  • PREDICTORS
  • MORTALITY
  • ANEMIA
  • REQUIREMENTS

Changes in Transfusion Practice Over Time in the PICU

Tools:

Journal Title:

Pediatric Critical Care Medicine

Volume:

Volume 14, Number 9

Publisher:

, Pages 843-850

Type of Work:

Article | Post-print: After Peer Review

Abstract:

OBJECTIVES: Recent randomized clinical trials have shown the efficacy of a restrictive transfusion strategy in critically ill children. The impact of these trials on pediatric transfusion practice is unknown. Additionally, long-term trends in pediatric transfusion practice in the ICU have not been described. We assessed transfusion practice over time, including the effect of clinical trial publication. DESIGN: Single-center, retrospective observational study. SETTING: A 10-bed PICU in an urban academic medical center. PATIENTS: Critically ill, nonbleeding children between the ages of 3 days and 14 years old, admitted to the University of Maryland Medical Center PICU between January 1, 1998, and December 31, 2009, excluding those with congenital heart disease, hemolytic anemia, and hemoglobinopathies. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: During the time period studied, 5,327 patients met inclusion criteria. Of these, 335 received at least one RBC transfusion while in the PICU. The overall proportion transfused declined from 10.5% in 1998 to 6.8% in 2009 (p = 0.007). Adjusted for acuity, the likelihood of transfusion decreased by calendar year of admission. In transfused patients, the pretransfusion hemoglobin level declined, from 10.5 g/dL to 9.3 g/dL, though these changes failed to meet statistical significance (p = 0.09). Neonatal age, respiratory failure, shock, multiple organ dysfunction syndrome, and acidosis were associated with an increased likelihood of transfusion in both univariate and multivariable models. CONCLUSIONS: The overall proportion of patients transfused between 1998 and 2009 decreased significantly. The magnitude of the decrease varied over time, and no additional change in transfusion practice occurred after the publication of a major pediatric clinical trial in 2007. Greater illness acuity and younger patient age were associated with an increased likelihood of transfusion.

Copyright information:

©2013 The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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