Differences in Prevalence of Transfusion Protocols between Critically Ill Neurologic and Non-Neurologic Patient Populations.

Abstract

This study describes the prevalence of blood transfusion protocols in ICUs caring for neurologically vs. non-neurologically injured patients across a sample of US ICUs. This prospective, observational multi-center cohort study is a subgroup analysis of the USCIITG-CIOS, comprising 69 ICUs across the US (25 medical, 24 surgical, 20 mixed ICUs). Sixty-four ICUs were in teaching hospitals. A total of 6179 patients were enrolled, with 1266 (20.4%) having central nervous system (CNS) primary diagnoses. We evaluated whether CNS versus non-CNS diagnosis was associated with care in ICUs with restrictive transfusion protocols (RTPs) or massive transfusion protocols (MTPs) and whether CNS versus non-CNS diagnosis was associated with receiving blood products or colloids during the initial 24 h of care. Protocol utilization in CNS vs. non-CNS patients was as follows: RTPs-36.9% vs. 42.9% (p < 0.001); MTPs-48.3% vs. 47.4% (p = 0.57). Blood product transfusions in the first 24 h of ICU care (comparing CNS vs. non-CNS patients) were as follows: packed red blood cells-4.3% vs. 14.6% (p < 0.001); fresh frozen plasma-2.9% vs. 5.1% (p < 0.001); colloid blood products-3.2% vs. 9.2% (p < 0.001). In this cohort, we found differences in ICU utilization of RTPs, but not MTPs, when comparing where critically ill patients with neurologic versus non-neurologic primary diagnoses received ICU care.