Variation in Blood Transfusion and Coagulation Management in Traumatic Brain Injury at the Intensive Care Unit: A Survey in 66 Neurotrauma Centers Participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Study
- 15 January 2018
- journal article
- research article
- Published by Mary Ann Liebert Inc in Journal of Neurotrauma
- Vol. 35 (2), 323-332
- https://doi.org/10.1089/neu.2017.5194
Abstract
Our aim was to describe current approaches and to quantify variability between European intensive care units (ICUs) in patients with traumatic brain injury (TBI). Therefore, we conducted a provider profiling survey as part of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. The ICU Questionnaire was sent to 68 centers from 20 countries across Europe and Israel. For this study, we used ICU questions focused on 1) hemoglobin target level (Hb-TL), 2) coagulation management, and 3) deep venous thromboembolism (DVT) prophylaxis. Seventy-eight participants, mostly intensivists and neurosurgeons of 66 centers, completed the ICU questionnaire. For ICU-patients, half of the centers (N = 34; 52%) had a defined Hb-TL in their protocol. For patients with TBI, 26 centers (41%) indicated an Hb-TL between 70 and 90 g/L and 38 centers (59%) above 90 g/L. To treat trauma-related hemostatic abnormalities, the use of fresh frozen plasma (N = 48; 73%) or platelets (N = 34; 52%) was most often reported, followed by the supplementation of vitamin K (N = 26; 39%). Most centers reported using DVT prophylaxis with anticoagulants frequently or always (N = 62; 94%). In the absence of hemorrhagic brain lesions, 14 centers (21%) delayed DVT prophylaxis until 72 h after trauma. If hemorrhagic brain lesions were present, the number of centers delaying DVT prophylaxis for 72 h increased to 29 (46%). Overall, a lack of consensus exists between European ICUs on blood transfusion and coagulation management. The results provide a baseline for the CENTER-TBI study, and the large between-center variation indicates multiple opportunities for comparative effectiveness research.Keywords
This publication has 42 references indexed in Scilit:
- Prothrombin complex concentrateThe Journal of Trauma and Acute Care Surgery, 2013
- A randomized, double-blinded, placebo-controlled pilot trial of anticoagulation in low-risk traumatic brain injuryThe Journal of Trauma and Acute Care Surgery, 2012
- TBI risk stratification at presentationThe Journal of Trauma and Acute Care Surgery, 2012
- Coagulopathy After Traumatic Brain InjuryNeurosurgery, 2012
- Dalteparin versus Unfractionated Heparin in Critically Ill PatientsThe New England Journal of Medicine, 2011
- Acute and delayed mild coagulopathy are related to outcome in patients with isolated traumatic brain injuryCritical Care, 2011
- Acute Coagulopathy in Isolated Blunt Traumatic Brain InjuryNeurocritical Care, 2009
- The effect of red blood cell transfusion on cerebral oxygenation and metabolism after severe traumatic brain injury*Critical Care Medicine, 2009
- Acute Coagulopathy of Trauma: Hypoperfusion Induces Systemic Anticoagulation and HyperfibrinolysisThe Journal of Trauma and Acute Care Surgery, 2008
- The effect of fresh frozen plasma in severe closed head injuryClinical Neurology and Neurosurgery, 2007