Transfusion Related Acute Lung Injury (TRALI) in Burn Patients
Bibliographic record
Abstract
TRALI is increasingly recognized as a complication of transfusion (TXN) but it has not been described in burn patients who are known to have clinical risk factors for Acute Lung Injury (ALI). Furthermore, characterization of TRALI in patients with existing Consensus-defined ALI or ARDS is also lacking. The purpose of the study was to identify possible TRALI in burn patients and to attempt to characterize TXN related pulmonary deterioration in burn patients with pre-existing ALI or ARDS. Retrospective review of mechanically ventilated and transfused burn patients at an adult regional burn center between 1/1/03 and 1/5/05 by a single reviewer. A blinded intensivist independently rated pre and post TXN chest radiographs (CXRs) after completing pilot consensus training on an unrelated group of CXRs (Mead M et al AJRCCM 2000). All values are presented as a mean ± SD. There were 37 ventilated and transfused patients. Following exclusions (missing pre or post CXR or PaO2/FiO2 ratio) there were 25 patients, (age 51 ± 19 yrs, % TBSA burns 30 ± 19, full thickness %BSA 17 ± 19, with a 24% incidence of smoke inhalation), who received 124 TXNs. New Consensus-defined ALI developed within 6 hours following 4 TXN events. Pulmonary infection or smoke inhalation co-existed during 3 of these TXNs but in the remaining TXN there were no precipitating causes other than the transfusion, suggesting probable TRALI (incidence 0.8%). Existing Consensus-defined ALI or ARDS was present prior to 63 (51%) of the TXNs. Definite worsening of the CXR combined with a deterioration in the PaO2/FiO2 ratio within 6 hours of TXN occurred after 6 transfusions. Among these transfusions the mean reduction in the PaO2/FiO2 ratio was 18% (range 9%–21%), and the mean pre and post TXN PaO2/FiO2 ratios were significantly different (204 ± 65 vs 167 ± 50 p=0.003). In 4 of these TXNs co-existing infection could have contributed, but in 2 of the TXNs no other precipitating causes other than the transfusion were present, suggesting a TXN related pulmonary deterioration (incidence 3.2%).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".