BREAKING THE MYTH ABOUT EARLY BLOOD TRANSFUSIONS IN A BURN
MASS CASUALTY INCIDENT
Shevonne S. Satahoo MDa, James S. Davis MDa, Eleanor de Asis MSMb, Sherry Shariatmadar
MDb, Louis R. Pizano MD MBAa, Nicholas Namias MD MBAa, Carl I. Schulman MD PhD
MSPHa, Mauricio Lynn MDa,
a
DeWitt-Daughtry Department of Surgery, University of Miami/Jackson Memorial Hospital,
Miami, Florida
b
Department of Pathology, University of Miami/Jackson Memorial Hospital, Miami, Florida
Objectives: A Mass Casualty Incident (MCI) could result in a large number of severely burned
patients. Surge capacity planning for a burn disaster should include sources for immediate
augmentation of personnel, equipment and specific supplies and medications. This study aimed
to estimate how much blood products would be needed in the first 48 hours after a burn MCI and
determine predictors of transfusions in this population.
Methods: Local burn registry was queried for adult patients who had TBSA burn ≥20% and an
operative procedure from November 2006 to January 2012. Demographic data was collected.
Transfusion records for the first 2 weeks of hospitalization were recorded. Student’s t-test, χ2 test
and multivariate regression were done to determine significant risk factors for requiring
transfusions. P-value <0.05 was considered significant.
Results: Total 110 patients were included. Patient demographics are shown in Table 1. The
requirement for blood products is listed in Table 2. In the first 48 hours, only 9.1% required
transfusion of any blood products. TBSA>40% was the only significant predictor when
evaluating both the need for transfusion, as well as transfusion of greater than 2 units of PRBCs
(p=0.011, p=0.026 respectively). However, by 2 weeks, 71% of patients required a transfusion.
TBSA>40% and age were significant predictors when evaluating both the need for a transfusion
of PRBCs, as well as transfusion of greater than 2 units. In both scenarios, TBSA (p=0.002) and
age (0.036) remained significant predictors in a multivariate analysis.
Conclusion: In burn patients, less than 10% will require transfusion of any blood products in the
first 48 hours; therefore there is no need for frantic mobilization of blood products or donations
after a burn MCI. However, planning for a burn disaster should include sources for additional
blood products within the first 2 weeks.
Shevonne S. Satahoo
P.O. Box 016960 (D-40),
Miami, FL 33101
Phone: 305-585-1290
Fax: 305-326-7065
Email: sssatahoo@med.miami.edu
Table 1. Patient demographics.
Age (years)
Sex
Male
Female
Mechanism
Flame
Scald
Explosion
Electric
Abrasion
TBSA
3rd degree
Inhalation
Yes
No
43 (IQR 21)
79% (n=87)
21% (n=23)
72% (n=79)
15% (n=17)
6% (n=6)
6% (n=6)
1% (n=1)
36% (IQR 24%)
12% (IQR 29%)
25% (n=27)
75% (n=82)
Table 2. Patient blood requirements at different time points during hospitalization.
mL of product (mean ± SD)
Units of product (mean ± SD)
74±315
4.7±49
42±199
0.25±1.05
0.02±0.25
0.21±1.0
369±597
6.9±54
40±196
1.23±1.99
0.03±0.27
0.20±0.98
48 hrs hospitalization
Packed Red Blood Cells (PRBCs)
Platelets
Fresh Frozen Plasma
First Operation
Packed Red Blood Cells
Platelets
Fresh Frozen Plasma
2 weeks hospitalization
Packed Red Blood Cells
Platelets
Fresh Frozen Plasma
1388±1529
49±192
122±413
33 patients (30%) had no transfusions at 2 weeks.
4.63±5.10
0.25±0.96
0.61±2.07