Trends in blood transfusion among hospitalized children with sickle cell disease

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.

Keywords: epidemiology; health care utilization; outcomes research; sickle cell disease.

Fig. 1

Odds of blood transfusions among children with sickle cell disease (1997–2009) according to diagnosis. Dots indicate odds ratios and error bars indicate 95% confidence intervals for SCD-related hospitalizations overall and specific principal diagnoses (x-axis) for the time frame 1997–2009. Results adjusted for child- and hospital-level factors. ACS, acute chest syndrome; VOC, vaso-occlusive crisis.

Fig. 2

Odds of blood transfusions among children with sickle cell disease (1997–2009) according to age. Dots indicate odds ratios and error bars indicate 95% confidence intervals for overall study population and across age categories (x-axis) for the time frame 1997–2009. Results adjusted for child- and hospita-level factors.