Determinants of red blood cell transfusions in a pediatric critical care unit: A prospective, descriptive epidemiological study

Objective: To determine the incidence and to characterize the determinants of red blood cell transfusions in critically ill children. Design: Prospective, descriptive epidemiologic study. Setting: A single-center, multidisciplinary, tertiary care level, university-affiliated, pediatric intensive care unit (PICU). Patients: Critically ill children. Interventions: None. Measurements and Main Results: Of 1,047 consecutive admissions over a 1-yr period, 985 were retained for study. At least one transfusion was given in 139 cases (14%). Incidence rate of transfusion was 304 transfusions/1,000 cases. Possible determinants of red blood cell transfusions were identified and prospectively monitored during PICU stay until a first transfusion event (transfused cases) or up until the time of death or discharge from PICU (nontransfused cases). Four significant determinants of a first red blood cell transfusion event were retained in the multivariate analysis (odds ratio, 95% confidence interval, p): a hemoglobin level < 9.5 g/dL during PICU stay (13.26, 8.04-21.88, p <.001), an admission diagnosis of cardiac disease (8.07, 5.14-14.65, p <.001), an admission Pediatric Risk of Mortality score >10 (4.83, 2.33-10.04, p <.001), and the presence of multiple organ dysfunction syndrome during the stay (2.06,1.18-3.57, p=.01). Conclusion: A significant proportion of critically ill children receive at least one red blood cell transfusion during their PICU stay. Presence of anemia, cardiac disease, severe critical illness, and multiple organ dysfunction syndrome are the most significant determinants of red blood cell transfusions in PICU.