Variation in red cell transfusion decisions in the intensive care unit: a nationwide survey in the Netherlands

Abstract

Background and Objectives Most guidelines recommend a restrictive transfusiontrigger of 7 g/dl. It is unclear whether this resulted in more uniform transfusionpractices. The primary objective was to uncover the extent of variation in trans-fusion decisions within four scenarios of critically ill patients among critical carephysicians in the Netherlands.Materials and methods An online survey comprising four different hypotheticalclinical scenarios was sent to all members of the Dutch Society of Intensive Care.The scenarios represented patients with acute myocardial infarction (Hb 85 g/dl),abdominal sepsis (Hb 71 g/dl), traumatic brain injury (TBI) (Hb 79 g/dl) andpost-surgical complications (Hb 73 g/dl). The questions explored the decisionwhether or not to transfuse and a ranking of clinical characteristics playing themost important role in the transfusion decision.Results A total of 224 members (22%) participated in the study of whom 188(84%) completed all questions. The percentages of respondents that decided totransfuse ranged from 259% in the scenario with TBI to 816% in the scenariowith post-surgical complications. Most controversy was seen in the scenario withsepsis for which 432% decided to transfuse, whereas 568% decided not to. Hae-moglobin level, diagnosis and haemodynamics were most important for thetransfusion decision in all scenarios.Conclusions Physicians decided differently on red-blood-cell transfusion giventhe clinical scenarios and weighed clinical characteristics differently in theirtransfusion decisions. These findings suggest there still is substantial variation incritical care transfusion practice.