Transfusions and long-term functional outcomes in traumatic brain injury

Clinical article

Matthew A. Warner, Terence OKeeffe, Premal Bhavsar, Rashmi Shringer, Carol Moore, Caryn Harper, Christopher J. Madden, Ravi Sarode, Larry M. Gentilello, Ramon Diaz-Arrastia

Research output: Contribution to journalArticle

Abstract

Object. In this paper, the authors' goal was to examine the relationship between transfusion and long-term functional outcomes in moderately anemic patients (lowest hematocrit [HCT] level 21-30%) with traumatic brain injury (TBI). While evidence suggests that transfusions are associated with poor hospital outcomes, no study has examined transfusions and long-term functional outcomes in this population. The preferred transfusion threshold remains controversial. Methods. The authors performed a retrospective review of patients who were admitted with TBI between September 2005 and November 2007, extracting data such as HCT level, status of red blood cell transfusion, admission Glasgow Coma Scale (GCS) score, serum glucose, and length of hospital stay. Outcome measures assessed at 6 months were Glasgow Outcome Scale-Extended score, Functional Status Examination score, and patient death. A multivariate generalized linear model controlling for confounding variables was used to assess the association between transfusion and outcome. Results. During the study period, 292 patients were identified, and 139 (47.6%) met the criteria for moderate anemia. Roughly half (54.7%) underwent transfusions. Univariate analyses showed significant correlations between outcome score and patient age, admission GCS score, head Abbreviated Injury Scale score, number of days with an HCT level < 30%, highest glucose level, number of days with a glucose level > 200 mg/dl, length of hospital stay, number of patients receiving a transfusion, and transfusion volume. In multivariate analysis, admission GCS score, receiving a transfusion, and transfusion volume were the only variables associated with outcome (F = 2.458, p = 0.007; F = 11.694, p = 0.001; and F = 1.991, p = 0.020, respectively). There was no association between transfusion and death. Conclusions. Transfusions may contribute to poor long-term functional outcomes in anemic patients with TBI. Transfusion strategies should be aimed at patients with symptomatic anemia or physiological compromise, and transfusion volume should be minimized.

Original languageEnglish (US)
Pages (from-to)539-546
Number of pages8
JournalJournal of neurosurgery
Volume113
Issue number3
DOIs
StatePublished - Sep 1 2010
Externally publishedYes

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Glasgow Coma Scale
Length of Stay
Hematocrit
Anemia
Abbreviated Injury Scale
Outcome Assessment (Health Care)
Glasgow Outcome Scale
Erythrocyte Transfusion
Confounding Factors (Epidemiology)
Patient Admission
Traumatic Brain Injury
Craniocerebral Trauma
Linear Models
Multivariate Analysis
Glucose
Serum
Population

Keywords

  • Anemia
  • Functional outcome
  • Long-term outcome
  • Mortality
  • Transfusion
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Warner, M. A., OKeeffe, T., Bhavsar, P., Shringer, R., Moore, C., Harper, C., ... Diaz-Arrastia, R. (2010). Transfusions and long-term functional outcomes in traumatic brain injury: Clinical article. Journal of neurosurgery, 113(3), 539-546. https://doi.org/10.3171/2009.12.JNS091337

Transfusions and long-term functional outcomes in traumatic brain injury : Clinical article. / Warner, Matthew A.; OKeeffe, Terence; Bhavsar, Premal; Shringer, Rashmi; Moore, Carol; Harper, Caryn; Madden, Christopher J.; Sarode, Ravi; Gentilello, Larry M.; Diaz-Arrastia, Ramon.

In: Journal of neurosurgery, Vol. 113, No. 3, 01.09.2010, p. 539-546.

Research output: Contribution to journalArticle

Warner, MA, OKeeffe, T, Bhavsar, P, Shringer, R, Moore, C, Harper, C, Madden, CJ, Sarode, R, Gentilello, LM & Diaz-Arrastia, R 2010, 'Transfusions and long-term functional outcomes in traumatic brain injury: Clinical article', Journal of neurosurgery, vol. 113, no. 3, pp. 539-546. https://doi.org/10.3171/2009.12.JNS091337
Warner, Matthew A. ; OKeeffe, Terence ; Bhavsar, Premal ; Shringer, Rashmi ; Moore, Carol ; Harper, Caryn ; Madden, Christopher J. ; Sarode, Ravi ; Gentilello, Larry M. ; Diaz-Arrastia, Ramon. / Transfusions and long-term functional outcomes in traumatic brain injury : Clinical article. In: Journal of neurosurgery. 2010 ; Vol. 113, No. 3. pp. 539-546.
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abstract = "Object. In this paper, the authors' goal was to examine the relationship between transfusion and long-term functional outcomes in moderately anemic patients (lowest hematocrit [HCT] level 21-30{\%}) with traumatic brain injury (TBI). While evidence suggests that transfusions are associated with poor hospital outcomes, no study has examined transfusions and long-term functional outcomes in this population. The preferred transfusion threshold remains controversial. Methods. The authors performed a retrospective review of patients who were admitted with TBI between September 2005 and November 2007, extracting data such as HCT level, status of red blood cell transfusion, admission Glasgow Coma Scale (GCS) score, serum glucose, and length of hospital stay. Outcome measures assessed at 6 months were Glasgow Outcome Scale-Extended score, Functional Status Examination score, and patient death. A multivariate generalized linear model controlling for confounding variables was used to assess the association between transfusion and outcome. Results. During the study period, 292 patients were identified, and 139 (47.6{\%}) met the criteria for moderate anemia. Roughly half (54.7{\%}) underwent transfusions. Univariate analyses showed significant correlations between outcome score and patient age, admission GCS score, head Abbreviated Injury Scale score, number of days with an HCT level < 30{\%}, highest glucose level, number of days with a glucose level > 200 mg/dl, length of hospital stay, number of patients receiving a transfusion, and transfusion volume. In multivariate analysis, admission GCS score, receiving a transfusion, and transfusion volume were the only variables associated with outcome (F = 2.458, p = 0.007; F = 11.694, p = 0.001; and F = 1.991, p = 0.020, respectively). There was no association between transfusion and death. Conclusions. Transfusions may contribute to poor long-term functional outcomes in anemic patients with TBI. Transfusion strategies should be aimed at patients with symptomatic anemia or physiological compromise, and transfusion volume should be minimized.",
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AU - Moore, Carol

AU - Harper, Caryn

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N2 - Object. In this paper, the authors' goal was to examine the relationship between transfusion and long-term functional outcomes in moderately anemic patients (lowest hematocrit [HCT] level 21-30%) with traumatic brain injury (TBI). While evidence suggests that transfusions are associated with poor hospital outcomes, no study has examined transfusions and long-term functional outcomes in this population. The preferred transfusion threshold remains controversial. Methods. The authors performed a retrospective review of patients who were admitted with TBI between September 2005 and November 2007, extracting data such as HCT level, status of red blood cell transfusion, admission Glasgow Coma Scale (GCS) score, serum glucose, and length of hospital stay. Outcome measures assessed at 6 months were Glasgow Outcome Scale-Extended score, Functional Status Examination score, and patient death. A multivariate generalized linear model controlling for confounding variables was used to assess the association between transfusion and outcome. Results. During the study period, 292 patients were identified, and 139 (47.6%) met the criteria for moderate anemia. Roughly half (54.7%) underwent transfusions. Univariate analyses showed significant correlations between outcome score and patient age, admission GCS score, head Abbreviated Injury Scale score, number of days with an HCT level < 30%, highest glucose level, number of days with a glucose level > 200 mg/dl, length of hospital stay, number of patients receiving a transfusion, and transfusion volume. In multivariate analysis, admission GCS score, receiving a transfusion, and transfusion volume were the only variables associated with outcome (F = 2.458, p = 0.007; F = 11.694, p = 0.001; and F = 1.991, p = 0.020, respectively). There was no association between transfusion and death. Conclusions. Transfusions may contribute to poor long-term functional outcomes in anemic patients with TBI. Transfusion strategies should be aimed at patients with symptomatic anemia or physiological compromise, and transfusion volume should be minimized.

AB - Object. In this paper, the authors' goal was to examine the relationship between transfusion and long-term functional outcomes in moderately anemic patients (lowest hematocrit [HCT] level 21-30%) with traumatic brain injury (TBI). While evidence suggests that transfusions are associated with poor hospital outcomes, no study has examined transfusions and long-term functional outcomes in this population. The preferred transfusion threshold remains controversial. Methods. The authors performed a retrospective review of patients who were admitted with TBI between September 2005 and November 2007, extracting data such as HCT level, status of red blood cell transfusion, admission Glasgow Coma Scale (GCS) score, serum glucose, and length of hospital stay. Outcome measures assessed at 6 months were Glasgow Outcome Scale-Extended score, Functional Status Examination score, and patient death. A multivariate generalized linear model controlling for confounding variables was used to assess the association between transfusion and outcome. Results. During the study period, 292 patients were identified, and 139 (47.6%) met the criteria for moderate anemia. Roughly half (54.7%) underwent transfusions. Univariate analyses showed significant correlations between outcome score and patient age, admission GCS score, head Abbreviated Injury Scale score, number of days with an HCT level < 30%, highest glucose level, number of days with a glucose level > 200 mg/dl, length of hospital stay, number of patients receiving a transfusion, and transfusion volume. In multivariate analysis, admission GCS score, receiving a transfusion, and transfusion volume were the only variables associated with outcome (F = 2.458, p = 0.007; F = 11.694, p = 0.001; and F = 1.991, p = 0.020, respectively). There was no association between transfusion and death. Conclusions. Transfusions may contribute to poor long-term functional outcomes in anemic patients with TBI. Transfusion strategies should be aimed at patients with symptomatic anemia or physiological compromise, and transfusion volume should be minimized.

KW - Anemia

KW - Functional outcome

KW - Long-term outcome

KW - Mortality

KW - Transfusion

KW - Traumatic brain injury

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