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Transfusion practices for acute traumatic brain injury: a survey of physicians at US trauma centers

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Abstract

Purpose

To determine whether physician specialty influences transfusion threshold in patients with acute severe traumatic brain injury (TBI).

Methods

We surveyed transfusion preferences of chiefs of trauma surgery, chairs of neurosurgery, and surgical and neurosurgical ICU directors at all 187 US Level I trauma centers using a scenario-based, multiple-choice instrument administered by mail. We evaluated the hemoglobin value used as a transfusion threshold for patients with severe acute TBI in several scenarios as well as opinions regarding the rationale for transfusion.

Results

The response rate was 58% (312/534). Mean time in practice was 17 ± 8 years and 65% were board certified in critical care. Neurosurgeons (NS) used a greater mean hemoglobin threshold for transfusion of TBI patients than trauma surgeons (TS) and non-surgeon intensivists (CC) whether the intracranial pressure was normal (8.3 ± 1.2, 7.5 ± 1.0, and 7.5 ± 0.8 g/dL; NS, TS, and CC, respectively, P < 0.001) or elevated (8.9 ± 1.1, 8.0 ± 1.1, and 8.4 ± 1.1 g/dL; NS, TS, and CC, respectively, P < 0.001). All three groups commonly believed that secondary ischemic injury is an important problem following TBI (74, 66, and 63%, P = 0.32), but fewer NS believed that transfusions have important immunodulatory effects (25, 91, and 83%, P < 0.001).

Conclusions

Neurosurgeons prefer more liberal transfusion of TBI patients than TS and CC, suggesting that actual practice may depend largely on which specialist is primarily managing care. The observed clinical equipoise would justify a randomized trial of liberal versus restrictive transfusion strategies in patients with TBI.

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Author information

Authors and Affiliations

  1. Department of Surgery, University of California Davis Medical Center, 2315 Stockton Blvd, Room 4206, Sacramento, CA, 95817, USA

    Matthew J. Sena, Ryan M. Rivers, Felix D. Battistella & Garth H. Utter

  2. Department of Neurological Surgery, University of California Davis Medical Center, 4860 Y St., Suite 3740, Sacramento, CA, 95817, USA

    J. Paul Muizelaar

Authors
  1. Matthew J. Sena
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  2. Ryan M. Rivers
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  3. J. Paul Muizelaar
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  4. Felix D. Battistella
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  5. Garth H. Utter
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Corresponding author

Correspondence to Matthew J. Sena.

Additional information

Felix D. Battistella: deceased.

This study was funded by the Department of Surgery, University of California, Davis Medical Center.

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Sena, M.J., Rivers, R.M., Muizelaar, J.P. et al. Transfusion practices for acute traumatic brain injury: a survey of physicians at US trauma centers. Intensive Care Med 35, 480–488 (2009). https://doi.org/10.1007/s00134-008-1289-z

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  • DOI: https://doi.org/10.1007/s00134-008-1289-z

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