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Trends in blood transfusion among hospitalized children with sickle cell disease
Author(s) -
Raphael Jean L.,
Oyeku Suzette O.,
Kowalkowski Marc A.,
Mueller Brigitta U.,
Ellison Angela M.
Publication year - 2013
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.24630
Subject(s) - medicine , odds ratio , acute chest syndrome , logistic regression , blood transfusion , pneumonia , multivariate analysis , odds , pediatrics , confidence interval , disease , anemia , emergency medicine , sickle cell anemia
Abstract Background Blood transfusions represent a major therapeutic option in acute management of sickle cell disease (SCD). Few data exist documenting trends in transfusion among children with SCD, particularly during hospitalization. Procedure This was an analysis of cross‐sectional data of hospital discharges within the Kid's Inpatient Database (years 1997, 2000, 2003, 2006, 2009). Hospitalizations for children (0–18 years) with a primary or secondary SCD‐related diagnosis were examined. The primary outcome was blood transfusion. Trends in transfusion were assessed using weighted multivariate logistic regression in a merged dataset with year as the primary independent variable. Co‐variables consisted of child and hospital characteristics. Multivariate logistic regression was conducted for 2009 data to assess child and hospital‐level factors associated with transfusion. Results From 1997 to 2009, the percentage of SCD‐related hospitalizations with transfusion increased from 14.2% to 28.8% ( P < 0.0001). Among all SCD‐related hospitalizations, the odds of transfusion increased over 20% for each successive study interval. Hospitalizations with vaso‐occlusive pain crisis (OR 1.35, 95% CI 1.27–1.43) or acute chest syndrome/pneumonia (OR 1.24, 95% CI 1.13–1.35) as the primary diagnoses had the highest odds of transfusion for each consecutive study interval. Older age and male gender were associated with higher odds of transfusion. Conclusions Blood transfusion is increasing over time among hospitalized children with SCD. Further study is warranted to identify indications contributing to the rise in transfusions and if transfusions in the inpatient setting have been used appropriately. Future studies should also assess the impact of rising trends on morbidity, mortality, and other health‐related outcomes. Pediatr Blood Cancer 2013;60:1753–1758. © 2013 Wiley Periodicals, Inc.