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J Crit Care. 2020 Feb;55:140-144. doi: 10.1016/j.jcrc.2019.10.003. Epub 2019 Oct 23.

Variation in red cell transfusion practice in the intensive care unit - An international survey.

Author information

1
Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands; Department of Intensive Care Medicine, Leiden University Medical Centre, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
2
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
3
Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands.
4
Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.
5
Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
6
Department of Intensive Care Medicine, Leiden University Medical Centre, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: m.s.arbous@lumc.nl.

Abstract

PURPOSE:

Unclear recommendations in transfusion guidelines may possibly lead to inconsistency in treatment of patients admitted to the intensive care unit. This study aimed to uncover variation in red blood cell (RBC) transfusion decisions in the ICU worldwide.

METHODS:

Members of the European Society of Intensive Care Medicine (ESICM) were requested to complete an online questionnaire which included four different hypothetical clinical scenarios. The scenarios represented patients with acute myocardial infarction (AMI), abdominal sepsis, traumatic brain injury (TBI) and post-surgical complications. Hemoglobin level was 7∙3 g/dL in all scenarios. The questionnaire explored the physicians' transfusion decision in each clinical scenario and identified patient characteristics that were most influential in the transfusion decision.

RESULTS:

In total 211 members participated in the study, of whom 142 (67%) completed the entire survey. Most variation was observed in the clinical scenario of sepsis, in which 49% decided to transfuse and 51% decided not to. In the clinical scenarios of AMI, TBI and post-surgical complications this was respectively; 75/25%, 35/65% and 66/34%.

CONCLUSIONS:

Critical care physicians differed in outcome of RBC transfusion decisions and weighed patient characteristics differently. These findings indicate that variation in transfusion practice amongst critical care physicians exists.

KEYWORDS:

Critical care; Decision-making; Intensive care; Red blood cell; Survey; Transfusion

PMID:
31715532
DOI:
10.1016/j.jcrc.2019.10.003

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