You are here

  • Home
  • Archive
  • Volume 7, Issue 3
  • Transfusion of red blood cells in patients with traumatic brain injuries admitted to Canadian trauma health centres: a multicentre cohort study

Article Text

Article menu

Download PDFPDF

XML
Intensive care
Research
Transfusion of red blood cells in patients with traumatic brain injuries admitted to Canadian trauma health centres: a multicentre cohort study
  1. Amélie Boutin1,2,
  2. Lynne Moore1,2,
  3. François Lauzier1,3,
  4. Michaël Chassé1,3,
  5. Shane English4,
  6. Ryan Zarychanski5,
  7. Lauralyn McIntyre4,
  8. Donald Griesdale6,
  9. Dean A Fergusson4,
  10. Alexis F Turgeon1,3
  1. 1Population Health and Optimal Health Practices Research Unit (Trauma—Emergency—Critical Care Medicine), CHU de Québec—Université Laval Research Centre, Université Laval, Québec, Québec, Canada
  2. 2Department of Social and Preventive Medicine, Université Laval, Québec, Québec, Canada
  3. 3Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Québec, Canada
  4. 4Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  5. 5Department of Internal Medicine, Sections of Critical Care Medicine, of Haematology and of Medical Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
  6. 6Department of Anesthesia, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Alexis F Turgeon; alexis.turgeon{at}fmed.ulaval.ca

Abstract

Background Optimisation of healthcare practices in patients sustaining a traumatic brain injury is of major concern given the high incidence of death and long-term disabilities. Considering the brain's susceptibility to ischaemia, strategies to optimise oxygenation to brain are needed. While red blood cell (RBC) transfusion is one such strategy, specific RBC strategies are debated. We aimed to evaluate RBC transfusion frequency, determinants of transfusions and associated clinical outcomes.

Methods We conducted a retrospective multicentre cohort study using data from the National Trauma Registry of Canada. Patients admitted with moderate or severe traumatic brain injury to participating hospitals between April 2005 and March 2013 were eligible. Patient information on blood products, comorbidities, interventions and complications from the Discharge Abstract Database were linked to the National Trauma Registry data. Relative weights analyses evaluated the contribution of each determinant. We conducted multivariate robust Poisson regression to evaluate the association between potential determinants, mortality, complications, hospital-to-home discharge and RBC transfusion. We also used proportional hazard models to evaluate length of stay for time to discharge from ICU and hospital.

Results Among the 7062 patients with traumatic brain injury, 1991 patients received at least one RBC transfusion during their hospital stay. Female sex, anaemia, coagulopathy, sepsis, bleeding, hypovolemic shock, other comorbid illnesses, serious extracerebral trauma injuries were all significantly associated with RBC transfusion. Serious extracerebral injuries altogether explained 61% of the observed variation in RBC transfusion. Mortality (risk ratio (RR) 1.23 (95% CI 1.13 to 1.33)), trauma complications (RR 1.38 (95% CI 1.32 to 1.44)) and discharge elsewhere than home (RR 1.88 (95% CI 1.75 to 2.04)) were increased in patients who received RBC transfusion. Discharge from ICU and hospital were also delayed in transfused patients.

Conclusions RBC transfusion is common in patients with traumatic brain injury and associated with unfavourable outcomes. Trauma severity is an important determinant of RBC transfusion. Prospective studies are needed to further evaluate optimal transfusion strategies in traumatic brain injury.

  • Transfusion
  • Traumatic Brain Injury
  • Red Blood Cell

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-014472

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors AB, LMo, FL, MC, RZ, DAF and AFT were involved in the conception and design. AB, LMo and AFT were involved in the acquisition. AB, LMo, FL, MC, SE, RZ, LMc, DG DAF and AFT were involved in the interpretation of data. AB, LMo and AFT drafted the manuscript. AB, LMo, FL, MC, SE, RZ, LMc, DG, DAF and AFT were involved in revising the manuscript and approved the version published.

    • Funding AB is recipient of a Frederick Banting and Charles Best Canada Graduate Scholarships Doctoral Award from the Canadian Institutes of Health Research (CIHR). LM, AFT and RZ are/were recipients of New Investigator Awards from the CIHR. AFT and FL are supported by the Traumatology Research Consortium of the Fonds de Recherche du Québec—Santé (FRQS). FL is a recipient of a salary support Award from the FRQS. AFT is the Canada Research Chair in Critical Care Neurology and Trauma.

    • Competing interests None declared.

    • Ethics approval The study received ethics approval by CHU de Québec—Université Laval.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.