Potential Factors Affecting Transfusion Policy and Length of Hospitalization in Patients with Thermal Injury

Journal of Biometrics & Biostatistics

article

Shin-YiTsai¹  Chon-FuLio¹  LeiyuShi¹  Shou-Chuan Shih¹  Yi-Fang Chang¹  Yu-Tien Chen¹  Sheng-KaiKevin Ma¹  Chien-FengKuo¹ 

[1] Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University

关键词: Restrictive transfusion policy;    Liberal transfusion policy;    Length of hospital stay (LOS);    Abbreviated Burn Severity Index (ABSI);    Formosa dust explosion;    Bacteremia;    Trauma-induced coagulopathy;    Blood management of burn care;    Postburn anemia;    Thromboelastometry;   

DOI  :  10.4172/2155-6180.1000414

来源: Hilaris Publisher

【 摘 要 】

Background: To explore the potential factors affecting time to discharge alive among burn patients and to determine the appropriateness of restrictive and liberal transfusion policies for burn patients. Study design and method: A retrospective analysis of 66 burn patients was conducted from 2013 to 2015. The average age was 26.7 and TBSA was 42.1% ( ± 25.9%). Data exploration of all dependent variables was performed to determine the normality and non-normally distributed variables were converted using Templeton’s two-step transformation involving percentile ranking. We assessed associations between significant clinical factors from and the outcome using Cox proportional hazards regression models with fixed and time-varying covariates. Impact of different transfusion threshold on the LOS was estimated by Cox proportional hazards regression and Kaplan-Meier curve. Results: A higher ABSI score (adj. HR, 0.28; P=0.017), present of bacteremia (adj. HR, 0.19; P=0.002) and pRBC transfusion (adj. HR, 0.55; P=0.001) were associated with significantly lower hazards of hospital discharge, suggesting a longer hospital stay. Further, the “restrictive” group also had a better outcome regarding the length of ICU stay (P=0.006) and hospital stay (P=0.003). There was a longer length of hospital stay in hemoglobin threshold greater than 8.5 g/ dl patients. (Log rank test, P=0.001). Transfusion threshold per se played an important role in extending the length of hospitalization (P=0.019). Conclusions: Restrictive RBC transfusion policy is more favorable to order appropriate blood components and helps the healthcare system to shorten LOS, reduce cost and complications.

【 授权许可】

Unknown