Boutin Amélie, Moore Lynne, Lauzier François, Chassé Michaël, English Shane, Zarychanski Ryan, McIntyre Lauralyn, Griesdale Donald, Fergusson Dean A, Turgeon Alexis F
Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Québec, Canada.
Department of Social and Preventive Medicine, Université Laval, Québec, Québec, Canada.
BMJ Open. 2017 Mar 29;7(3):e014472. doi: 10.1136/bmjopen-2016-014472.
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.
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.
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.
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.
鉴于创伤性脑损伤患者的高死亡率和长期残疾发生率，优化其医疗护理措施备受关注。考虑到大脑对缺血的易感性，需要采取优化脑氧合的策略。虽然红细胞（RBC）输血是其中一种策略，但具体的红细胞策略仍存在争议。我们旨在评估红细胞输血频率、输血的决定因素及相关临床结局。
我们利用加拿大国家创伤登记处的数据进行了一项回顾性多中心队列研究。2005年4月至2013年3月期间入住参与研究医院的中度或重度创伤性脑损伤患者符合条件。出院摘要数据库中关于血液制品、合并症、干预措施和并发症的患者信息与国家创伤登记处的数据相关联。相对权重分析评估了每个决定因素的贡献。我们进行了多变量稳健泊松回归，以评估潜在决定因素、死亡率、并发症、从医院到家出院以及红细胞输血之间的关联。我们还使用比例风险模型评估从重症监护病房和医院出院的住院时间。
在7062例创伤性脑损伤患者中，1991例患者在住院期间接受了至少一次红细胞输血。女性、贫血、凝血病、败血症、出血、低血容量性休克、其他合并症、严重的脑外创伤均与红细胞输血显著相关。严重的脑外损伤共解释了观察到的红细胞输血差异的61%。接受红细胞输血的患者死亡率（风险比（RR）1.23（95%可信区间1.13至1.33））、创伤并发症（RR 1.38（95%可信区间1.32至1.44））以及出院地点不是家（RR 1.88（95%可信区间1.75至2.04））均增加。输血患者从重症监护病房和医院出院也延迟。
红细胞输血在创伤性脑损伤患者中很常见，且与不良结局相关。创伤严重程度是红细胞输血的重要决定因素。需要进行前瞻性研究以进一步评估创伤性脑损伤的最佳输血策略。
