Blood utilization in children managed non-operatively for blunt solid organ injury

Abstract

Background: Blood product utilization is an important issue in health care, given the frequent shortages in hospitals and the societal burden required to maintain the supply. Therefore, we retrospectively audited our blunt spleen/liver trauma experience to determine the percentage of cross-matched blood that was transfused to see whether more stringent typing criteria should be applied.

Methods: A retrospective analysis of a recent 7-year experience with nonoperative management in patients with blunt spleen or liver injury was performed. Demographics, packed red blood cells prepared by cross-match, and transfusions were measured. Unmatched, O-type blood given in the trauma bay was excluded. Patients undergoing laparotomy for solid organ injury were excluded. Data are expressed as mean +/- standard deviation.

Results: During the study period, 130 patients were nonoperatively managed for spleen and/or liver injury. Mean age was 8.7 +/- 4.6 years, and 62% were male. The mean grade of injury was 2.4 +/- 0.9. A total of 187 units of packed red blood cells was ordered in 60 patients. A total of 46.5 units was administered to 22 patients, revealing a 24.9% transfusion rate for the units ordered in 36.7% of the patients for whom it was ordered. When patients with other major injuries and those with ongoing bleeding requiring an operation or who clinically required blood on presentation were excluded, there were 80 patients. In this stable population, 104 units of PRBCs were ordered for 29 patients. A total of 18 units was then transfused in 5 patients, for a 17.3% transfusion rate for the units orders in 17.2% of the patients for whom it was ordered. None of the 5 patients received transfusion the day of admission.

Conclusion: Hemodynamically stable patients with blunt spleen/liver injury triaged to conservative management should have their blood typed and be monitored closely for signs or laboratory values that would mandate a cross-match. According to our data, this strategy would safely improve utilization of blood bank resources.