Blood product transfusion in emergency department patients: a case-control study of practice patterns and impact on outcome

Abstract

BackgroundBlood product transfusion occurs in a significant percentage of intensive care unit (ICU) patients. Pulmonary complications, such as acute respiratory distress syndrome (ARDS), occurring in the setting of transfusion, are associated with increased morbidity and mortality. Contrary to the ICU setting, there is little evidence describing the epidemiology of transfusion in the emergency department (ED) or its potential impact on outcome. The objectives of this study were to: (1) characterize transfusion practices in the ED with respect to patient characteristics and pre-transfusion laboratory values; and (2) investigate the effect of ED blood product transfusion on the incidence of pulmonary complications after admission. We hypothesized that blood product transfusion would increase the event rate for pulmonary complications, and have a negative impact on other clinically significant outcomes.MethodsThis was a retrospective case-control study with one-one matching of 204 transfused ED patients to 204 non-transfused controls. The primary outcome was a composite pulmonary outcome that included: acute respiratory failure, new need for ICU admission, and ARDS. Multivariable logistic regression was used to evaluate the primary outcome as a function of transfusion.ResultsOne-hundred twenty four (60.8%) patients were transfused packed red blood cells (PRBC) in the ED. The mean pre-transfusion hemoglobin level was 8.5 g/dl. There were 73 patients with a hemoglobin value ≥10 g/dl; 19 (26.0%) received a PRBC transfusion. A total of 54 (26.5%) patients were transfused platelets. The main indications were thrombocytopenia (27.8%) and neurologic injury (24.1%). Ten patients had a platelet level <10,000 (guideline recommended threshold for transfusion to prevent spontaneous hemorrhage). The mean platelet count for neurologic injury patients was 197,000 prior to transfusion. The primary outcome occurred in 26 control patients (12.7%), as compared with 28 cases (13.7%). In multivariable logistic regression analysis, ED transfusion was not associated with an increased odds of primary outcome [adjusted OR 0.91 (0.48–1.72), P = 0.77]. The mortality rate was 10.8% in the cases and 8.8% in the controls, P = 0.51.ConclusionsA significant percentage of ED blood product transfusions are discordant with guideline recommendations. However, there was no association with ED transfusion and worse clinical outcome.Electronic supplementary materialThe online version of this article (doi:10.1186/s12245-017-0133-z) contains supplementary material, which is available to authorized users.

Red Blood Cell Transfusion in the Emergency Department: An Observational Cross-Sectional Multicenter Study

“…Furthermore, this procedure can be extremely time-consuming for nurses and needs close monitoring to avoid adverse events. Other studies in the USA, UK, and Spain showed similar numbers of daily transfused patients in the ED [13][14][15][16][17].…”

Acil Serviste Yapılan Kan Transfüzyonları Acil Servis İşleyişini Etkiliyor mu?

“…Beyer ve ark. 'larının yapmış olduğu başka bir çalışmada ise acil serviste en fazla GİS kanamalı hastalara (%22,1) transfüzyon yapıldığı saptanmış ve yine bu çalışmada anemi tanılı hastaların oranı % 10,8 olarak bulunmuştur 5 . Yoğun bakımlardaki transfüzyonları inceleyen bir çalışmada ise en fazla anemi tanılı hastalara transfüzyon yapıldığı bulunmuştur 8 .…”

“…Ülkemizde yapı-lan çalışmalarda acil serviste kan ve kan ürünlerinin transfüzyonu yapılan hastaların ortalama yaşları 60,6-61,3 olarak bulunmuştur 3,4 . Amerika Birleşik Devletleri'nde (ABD) yapılan bir çalışmada ise acil serviste kan transfüzyonu yapılan hastaların ortalama yaşı 62.0 olarak saptanmıştır 5 . Bizim yaptığımız çalışmada da kan transfüzyonu yapılan hastaların ortalama yaşı literatür ile uyumludur.…”

“…Ülkemizde transfüzyon yapılan hastaların cinsiyete göre dağılımını inceleyen çalışmalarda kadın popülasyonun oranları %39,0 -% 59,8 arasında saptanmıştır 3,6,7 Yurt dışında yapılan bir çalışmada ise transfüzyon yapılan hastalarda kadın oranı %52,9 olarak saptanmıştır 5 .Bizim çalışmamızda saptanan cinsiyet oranı da literatür ile uyumludur. Acil servis ve diğer transfüzyon yapılan merkezlerde çeşitli endikasyonlar ile kan ve kan ürünlerinin transfüzyonları yapılmaktadır.…”

Comments on: blood product transfusion in emergency department patients: a case control study of practice patterns and impact on outcome

“…We read with interest, the article entitled “Blood product transfusion in emergency department patients: a case-control study of practice patterns and impact on outcome” by Beyer and colleagues published in International Journal of Emergency Medicine [ 1 ]. While we congratulate the authors for their cogent thesis, we were concerned about a methodological issue that may have been overlooked in the peer review.…”