Blood component transfusion increases the risk of death in children with traumatic brain injury

Acker, Shannon N. MD; Partrick, David A. MD; Ross, James T. BS; Nadlonek, Nicole A. MD; Bronsert, Michael PhD; Bensard, Denis D. MDJournal of Trauma and 

Acute Care Surgery:

April 2014 - Volume 76 - Issue 4 - p 1082-1088

Pediatric patients sustaining TBI who receive blood transfusion and do not require operative intervention have worse outcomes compared with patients who do not receive transfusion. This includes an increased risk of death. These data suggest that a transfusion trigger of hemoglobin level at 8.0 g/dL in injured children with TBI may be beneficial.

Predicting the need for massive transfusion in trauma patients: The Traumatic Bleeding Severity Score

Ogura, Takayuki MD; Nakamura, Yoshihiko MD; Nakano, Minoru MD, PhD; Izawa, Yoshimitsu MD; Nakamura, Mitsunobu MD, PhD; Fujizuka, Kenji MD; Suzukawa, Masayuki MD, PhD; Lefor, Alan T. MD, MPH

Journal of Trauma and Acute Care Surgery:

May 2014 - Volume 76 - Issue 5 - p 1243-1250

In the development phase, five predictors of massive transfusion were identified, including age, systolic blood pressure, the Focused Assessment with Sonography for Trauma scan, severity of pelvic fracture, and lactate level. The maximum TBSS is 57 points. In the validation study, the average TBSS in patients who received massive transfusion was significantly greater (24.2 [6.7]) than the score of patients who did not (6.2 [4.7]) (p < 0.01). The area under the receiver operating characteristic curve, sensitivity, and specificity for a TBSS greater than 15 points was 0.985 (significantly higher than the other scoring systems evaluated at 0.892 and 0.813, respectively), 97.4%, and 96.2%, respectively.

CONCLUSION
The TBSS is simple to calculate using an available iOS application and is accurate in predicting the need for massive transfusion. Additional multicenter studies are needed to further validate this scoring system and further assess its utility.

Patient Blood Management in Elective Total Hip- and Knee-replacement Surgery (Part 2): A Randomized Controlled Trial on Blood Salvage as Transfusion Alternative Using a Restrictive Transfusion Policy in Patients with a Preoperative Hemoglobin above 13 g/dl

So-Osman, Cynthia M.D., Ph.D., M.Sc.; Nelissen, Rob G. H. H. M.D., Ph.D.; Koopman-van Gemert, Ankie W. M. M. M.D., Ph.D.; Kluyver, Ewoud M.D.; Pöll, Ruud G. M.D., Ph.D.; Onstenk, Ron M.D.; Van Hilten, Joost A. Ph.D.; Jansen-Werkhoven, Thekla M. Ph.D.; van den Hout, Wilbert B. Ph.D.; Brand, Ronald Ph.D.; Brand, Anneke M.D., Ph.D.

Anesthesiology:

April 2014 - Volume 120 - Issue 4 - p 852–860

 In this prospective randomized controlled trial including 1,759 patients with a preoperative hemoglobin level greater than 13 g/dl (and therefore ineligible for erythropoietin) undergoing hip or knee arthroplasty, autologous intra- and postoperative blood salvage devices were not effective as transfusion alternatives. The use of these devices did not reduce erythrocyte use and increased costs.