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A Comparative Analysis Of Presenting Characteristics And Transfusion Practices Of Burn Patients Treated At Level 1 And Non-level 1 Trauma Centers
Eloise W. Stanton, MD, Sean Donohue, MD, Justin Gillenwater, MD, Matthew Martin, MD, Kenji Inaba, MD, Haig Yeniksomshian, MD.
USC, Los Angeles, CA, USA.
Purpose: Blood transfusion is crucial in burn care. Level 1 trauma centers, known for managing severe cases, may have higher transfusion rates due to patient complexity and access to resources. This study aims to compare transfusion practices at Level 1 trauma centers with non-Level 1 centers to study blood product utilization in burns.
Methods: A retrospective cohort study using the Trauma Quality Improvement Project (TQIP) databank from 2017-2022 analyzed transfusion practices in burn patients. Burn injuries were identified via ICD-9/10 event codes. Presenting vitals, Glasgow Coma Scale (GCS) scores, and overall injury severity were compared. The primary exposure was trauma center level (Level 1 vs. non-Level 1), and the primary outcome was blood transfusion. Multivariable logistic regression assessed the association between trauma center level and transfusion while controlling for TBSA, inhalation injury, age, gender, and injury severity score (ISS).
Results: Among 319,941 patients, 72,474 were isolated burns. Of these, 48.0% were treated at Level 1 centers. Burn patients treated at level 1 centers had significantly lower presenting GCS scores, oxygen requirements, and higher ISS scores. No significant differences were observed in transfusion of platelets, packed red blood cells, or cryoprecipitate when controlling for covariates.
Conclusion: While Level 1 trauma centers manage more complex burn cases, there were no significant differences in transfusion practices for blood products such as platelets, packed red blood cells, or cryoprecipitate compared to non-Level 1 centers after adjusting for relevant covariates. This suggests that, despite differences in patient acuity, blood transfusion protocols are consistent across trauma center levels.
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