Transfusion Requirement in Burn Care Evaluation (TRIBE)

A Multicenter Randomized Prospective Trial of Blood Transfusion in Major Burn Injury

Tina L. Palmieri, James H. Holmes, Brett Arnoldo, Michael Peck, Bruce Potenza, Amalia Cochran, Booker T. King, William Dominic, Robert Cartotto, Dhaval Bhavsar, Nathan Kemalyan, Edward Tredget, Francois Stapelberg, David Mozingo, Bruce Friedman, David G. Greenhalgh, Sandra L. Taylor, Brad H. Pollock

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

OBJECTIVE:: Our objective was to compare outcomes of a restrictive to a liberal red cell transfusion strategy in 20% or more total body surface area (TBSA) burn patients. We hypothesized that the restrictive group would have less blood stream infection (BSI), organ dysfunction, and mortality. BACKGROUND:: Patients with major burns have major (>1 blood volume) transfusion requirements. Studies suggest that a restrictive blood transfusion strategy is equivalent to a liberal strategy. However, major burn injury is precluded from these studies. The optimal transfusion strategy in major burn injury is thus needed but remains unknown. METHODS:: This prospective randomized multicenter trial block randomized patients to a restrictive (hemoglobin 7–8?g/dL) or liberal (hemoglobin 10–11?g/dL) transfusion strategy throughout hospitalization. Data collected included demographics, infections, transfusions, and outcomes. RESULTS:: Eighteen burn centers enrolled 345 patients with 20% or more TBSA burn similar in age, TBSA burn, and inhalation injury. A total of 7054 units blood were transfused. The restrictive group received fewer blood transfusions: mean 20.3?±?32.7 units, median = 8 (interquartile range: 3, 24) versus mean 31.8?±?44.3 units, median = 16 (interquartile range: 7, 40) in the liberal group (P < 0.0001, Wilcoxon rank sum). BSI incidence, organ dysfunction, ventilator days, and time to wound healing (P > 0.05) were similar. In addition, there was no 30-day mortality difference: 9.5% restrictive versus 8.5% liberal (P = 0.892, χ test). CONCLUSIONS:: A restrictive transfusion strategy halved blood product utilization. Although the restrictive strategy did not decrease BSI, mortality, or organ dysfunction in major burn injury, these outcomes were no worse than the liberal strategy (Clinicaltrials.gov identifier NCT01079247).

Original languageEnglish (US)
JournalAnnals of Surgery
DOIs
StateAccepted/In press - Jul 10 2017

Fingerprint

Blood Transfusion
Body Surface Area
Wounds and Injuries
Mortality
Hemoglobins
Inhalation Burns
Infection
Burn Units
Blood Volume
Burns
Multicenter Studies
Hospitalization
Demography

ASJC Scopus subject areas

  • Surgery

Cite this

Transfusion Requirement in Burn Care Evaluation (TRIBE) : A Multicenter Randomized Prospective Trial of Blood Transfusion in Major Burn Injury. / Palmieri, Tina L.; Holmes, James H.; Arnoldo, Brett; Peck, Michael; Potenza, Bruce; Cochran, Amalia; King, Booker T.; Dominic, William; Cartotto, Robert; Bhavsar, Dhaval; Kemalyan, Nathan; Tredget, Edward; Stapelberg, Francois; Mozingo, David; Friedman, Bruce; Greenhalgh, David G.; Taylor, Sandra L.; Pollock, Brad H.

In: Annals of Surgery, 10.07.2017.

Research output: Contribution to journalArticle

Palmieri, TL, Holmes, JH, Arnoldo, B, Peck, M, Potenza, B, Cochran, A, King, BT, Dominic, W, Cartotto, R, Bhavsar, D, Kemalyan, N, Tredget, E, Stapelberg, F, Mozingo, D, Friedman, B, Greenhalgh, DG, Taylor, SL & Pollock, BH 2017, 'Transfusion Requirement in Burn Care Evaluation (TRIBE): A Multicenter Randomized Prospective Trial of Blood Transfusion in Major Burn Injury', Annals of Surgery. https://doi.org/10.1097/SLA.0000000000002408
Palmieri, Tina L. ; Holmes, James H. ; Arnoldo, Brett ; Peck, Michael ; Potenza, Bruce ; Cochran, Amalia ; King, Booker T. ; Dominic, William ; Cartotto, Robert ; Bhavsar, Dhaval ; Kemalyan, Nathan ; Tredget, Edward ; Stapelberg, Francois ; Mozingo, David ; Friedman, Bruce ; Greenhalgh, David G. ; Taylor, Sandra L. ; Pollock, Brad H. / Transfusion Requirement in Burn Care Evaluation (TRIBE) : A Multicenter Randomized Prospective Trial of Blood Transfusion in Major Burn Injury. In: Annals of Surgery. 2017.
@article{6ad5e909ba6444d19b0a0287e5ec4212,
title = "Transfusion Requirement in Burn Care Evaluation (TRIBE): A Multicenter Randomized Prospective Trial of Blood Transfusion in Major Burn Injury",
abstract = "OBJECTIVE:: Our objective was to compare outcomes of a restrictive to a liberal red cell transfusion strategy in 20{\%} or more total body surface area (TBSA) burn patients. We hypothesized that the restrictive group would have less blood stream infection (BSI), organ dysfunction, and mortality. BACKGROUND:: Patients with major burns have major (>1 blood volume) transfusion requirements. Studies suggest that a restrictive blood transfusion strategy is equivalent to a liberal strategy. However, major burn injury is precluded from these studies. The optimal transfusion strategy in major burn injury is thus needed but remains unknown. METHODS:: This prospective randomized multicenter trial block randomized patients to a restrictive (hemoglobin 7–8?g/dL) or liberal (hemoglobin 10–11?g/dL) transfusion strategy throughout hospitalization. Data collected included demographics, infections, transfusions, and outcomes. RESULTS:: Eighteen burn centers enrolled 345 patients with 20{\%} or more TBSA burn similar in age, TBSA burn, and inhalation injury. A total of 7054 units blood were transfused. The restrictive group received fewer blood transfusions: mean 20.3?±?32.7 units, median = 8 (interquartile range: 3, 24) versus mean 31.8?±?44.3 units, median = 16 (interquartile range: 7, 40) in the liberal group (P < 0.0001, Wilcoxon rank sum). BSI incidence, organ dysfunction, ventilator days, and time to wound healing (P > 0.05) were similar. In addition, there was no 30-day mortality difference: 9.5{\%} restrictive versus 8.5{\%} liberal (P = 0.892, χ test). CONCLUSIONS:: A restrictive transfusion strategy halved blood product utilization. Although the restrictive strategy did not decrease BSI, mortality, or organ dysfunction in major burn injury, these outcomes were no worse than the liberal strategy (Clinicaltrials.gov identifier NCT01079247).",
author = "Palmieri, {Tina L.} and Holmes, {James H.} and Brett Arnoldo and Michael Peck and Bruce Potenza and Amalia Cochran and King, {Booker T.} and William Dominic and Robert Cartotto and Dhaval Bhavsar and Nathan Kemalyan and Edward Tredget and Francois Stapelberg and David Mozingo and Bruce Friedman and Greenhalgh, {David G.} and Taylor, {Sandra L.} and Pollock, {Brad H.}",
year = "2017",
month = "7",
day = "10",
doi = "10.1097/SLA.0000000000002408",
language = "English (US)",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Transfusion Requirement in Burn Care Evaluation (TRIBE)

T2 - A Multicenter Randomized Prospective Trial of Blood Transfusion in Major Burn Injury

AU - Palmieri, Tina L.

AU - Holmes, James H.

AU - Arnoldo, Brett

AU - Peck, Michael

AU - Potenza, Bruce

AU - Cochran, Amalia

AU - King, Booker T.

AU - Dominic, William

AU - Cartotto, Robert

AU - Bhavsar, Dhaval

AU - Kemalyan, Nathan

AU - Tredget, Edward

AU - Stapelberg, Francois

AU - Mozingo, David

AU - Friedman, Bruce

AU - Greenhalgh, David G.

AU - Taylor, Sandra L.

AU - Pollock, Brad H.

PY - 2017/7/10

Y1 - 2017/7/10

N2 - OBJECTIVE:: Our objective was to compare outcomes of a restrictive to a liberal red cell transfusion strategy in 20% or more total body surface area (TBSA) burn patients. We hypothesized that the restrictive group would have less blood stream infection (BSI), organ dysfunction, and mortality. BACKGROUND:: Patients with major burns have major (>1 blood volume) transfusion requirements. Studies suggest that a restrictive blood transfusion strategy is equivalent to a liberal strategy. However, major burn injury is precluded from these studies. The optimal transfusion strategy in major burn injury is thus needed but remains unknown. METHODS:: This prospective randomized multicenter trial block randomized patients to a restrictive (hemoglobin 7–8?g/dL) or liberal (hemoglobin 10–11?g/dL) transfusion strategy throughout hospitalization. Data collected included demographics, infections, transfusions, and outcomes. RESULTS:: Eighteen burn centers enrolled 345 patients with 20% or more TBSA burn similar in age, TBSA burn, and inhalation injury. A total of 7054 units blood were transfused. The restrictive group received fewer blood transfusions: mean 20.3?±?32.7 units, median = 8 (interquartile range: 3, 24) versus mean 31.8?±?44.3 units, median = 16 (interquartile range: 7, 40) in the liberal group (P < 0.0001, Wilcoxon rank sum). BSI incidence, organ dysfunction, ventilator days, and time to wound healing (P > 0.05) were similar. In addition, there was no 30-day mortality difference: 9.5% restrictive versus 8.5% liberal (P = 0.892, χ test). CONCLUSIONS:: A restrictive transfusion strategy halved blood product utilization. Although the restrictive strategy did not decrease BSI, mortality, or organ dysfunction in major burn injury, these outcomes were no worse than the liberal strategy (Clinicaltrials.gov identifier NCT01079247).

AB - OBJECTIVE:: Our objective was to compare outcomes of a restrictive to a liberal red cell transfusion strategy in 20% or more total body surface area (TBSA) burn patients. We hypothesized that the restrictive group would have less blood stream infection (BSI), organ dysfunction, and mortality. BACKGROUND:: Patients with major burns have major (>1 blood volume) transfusion requirements. Studies suggest that a restrictive blood transfusion strategy is equivalent to a liberal strategy. However, major burn injury is precluded from these studies. The optimal transfusion strategy in major burn injury is thus needed but remains unknown. METHODS:: This prospective randomized multicenter trial block randomized patients to a restrictive (hemoglobin 7–8?g/dL) or liberal (hemoglobin 10–11?g/dL) transfusion strategy throughout hospitalization. Data collected included demographics, infections, transfusions, and outcomes. RESULTS:: Eighteen burn centers enrolled 345 patients with 20% or more TBSA burn similar in age, TBSA burn, and inhalation injury. A total of 7054 units blood were transfused. The restrictive group received fewer blood transfusions: mean 20.3?±?32.7 units, median = 8 (interquartile range: 3, 24) versus mean 31.8?±?44.3 units, median = 16 (interquartile range: 7, 40) in the liberal group (P < 0.0001, Wilcoxon rank sum). BSI incidence, organ dysfunction, ventilator days, and time to wound healing (P > 0.05) were similar. In addition, there was no 30-day mortality difference: 9.5% restrictive versus 8.5% liberal (P = 0.892, χ test). CONCLUSIONS:: A restrictive transfusion strategy halved blood product utilization. Although the restrictive strategy did not decrease BSI, mortality, or organ dysfunction in major burn injury, these outcomes were no worse than the liberal strategy (Clinicaltrials.gov identifier NCT01079247).

UR - http://www.scopus.com/inward/record.url?scp=85023206053&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85023206053&partnerID=8YFLogxK

U2 - 10.1097/SLA.0000000000002408

DO - 10.1097/SLA.0000000000002408

M3 - Article

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

ER -