Blood product transfusion in major burned pediatric patients: A case-control study

Objective: To evaluate the impact of blood product transfusions on clinical outcomes, including mortality, dialysis requirement, and infection, in pediatric patients with extensive burns. Material and Methods: This case-control study included pediatric patients with ≥20% total body surface area burns who were treated at a university hospital burn center between 2012 and 2022. Deceased patients were classified as cases, and discharged patients as controls. The primary outcome was mortality, and the secondary outcomes were dialysis. Multivariable logistic regression was used to assess associations between blood product usage and clinical outcomes, adjusting for burn severity, surgical duration, and infection. Results: One hundred-thirteen patients were analyzed, with 93 discharged and 20 deceased. Platelet transfusion in the intensive care unit (ICU) was associated with lower mortality (odds ratio: 0.663, 95% confidence interval: 0.484-0.909, p=0.011) but with increased dialysis requirements. Moreover, albumin, red blood cell, and fresh frozen plasma transfusions in the ICU were correlated with an increased risk of infection. Albumin administration in the ICU was associated with decreased mortality (hazard ratio =0.848, 95% confidence interval: 0.735-0.977, p=0.023). Conclusion: The findings suggest that burn injury severity, the amount of blood products transfused, and the timing of transfusions are critical factors in determining patient outcomes. Future research should focus on establishing evidence-based transfusion thresholds.