![]() ![]() The emergency department (ED) is the entry point for the majority of patients in the ICU. This has led to a well-defined epidemiology of transfusion practices in the ICU, and evidence-based guideline recommendations in the critical care setting. ![]() The previous two decades have seen intense investigation into transfusion practices, and their impact on outcome in the ICU. In a general intensive care unit (ICU) population, 20–50% of patients are transfused blood products during their ICU stay. ![]() However, there was no association with ED transfusion and worse clinical outcome. ConclusionsĪ significant percentage of ED blood product transfusions are discordant with guideline recommendations. The mortality rate was 10.8% in the cases and 8.8% in the controls, P = 0.51. In multivariable logistic regression analysis, ED transfusion was not associated with an increased odds of primary outcome. The primary outcome occurred in 26 control patients (12.7%), as compared with 28 cases (13.7%). The mean platelet count for neurologic injury patients was 197,000 prior to transfusion. Ten patients had a platelet level <10,000 (guideline recommended threshold for transfusion to prevent spontaneous hemorrhage). The main indications were thrombocytopenia (27.8%) and neurologic injury (24.1%). A total of 54 (26.5%) patients were transfused platelets. There were 73 patients with a hemoglobin value ≥10 g/dl 19 (26.0%) received a PRBC transfusion. The mean pre-transfusion hemoglobin level was 8.5 g/dl. One-hundred twenty four (60.8%) patients were transfused packed red blood cells (PRBC) in the ED. Multivariable logistic regression was used to evaluate the primary outcome as a function of transfusion. The primary outcome was a composite pulmonary outcome that included: acute respiratory failure, new need for ICU admission, and ARDS. This was a retrospective case-control study with one-one matching of 204 transfused ED patients to 204 non-transfused controls. We hypothesized that blood product transfusion would increase the event rate for pulmonary complications, and have a negative impact on other clinically significant outcomes. 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. 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. Pulmonary complications, such as acute respiratory distress syndrome (ARDS), occurring in the setting of transfusion, are associated with increased morbidity and mortality. Blood product transfusion occurs in a significant percentage of intensive care unit (ICU) patients. ![]()
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