RBC transfusion practices among critically ill patients: has evidence changed practice?

Area of Science:

• Critical Care Medicine
• Hematology
• Health Services Research

Background:

• The Transfusion Requirements in Critical Care (TRICC) trial (1999) provided evidence for lower hemoglobin thresholds for red blood cell (RBC) transfusions in intensive care unit (ICU) patients.
• The impact of this evidence on clinical practice patterns in a large, population-based cohort remains largely unknown.

Purpose of the Study:

• To investigate the influence of the TRICC trial findings on RBC transfusion practices over time.
• To compare transfusion trends in hospitals with different intensive care unit (ICU) volumes.

Main Methods:

• Retrospective population-based cohort study.
• Analysis of 73,385 nonsurgical adult ICU patients across 35 Maryland hospitals from 1994 to 2007.
• Logistic regression modeling to assess trends in RBC transfusion odds before and after the TRICC trial publication, stratified by hospital ICU volume.

Main Results:

• Unadjusted RBC transfusion odds increased from 7.9% (1994-1998) to 14.7% (1999-2007).
• In the post-TRICC period, adjusted RBC transfusion odds decreased annually in high-volume ICUs (OR, 0.96) but increased annually in low-volume ICUs (OR, 1.10).
• These trends differed significantly between hospital types (p<0.001).

Conclusions:

• The TRICC trial's evidence did not lead to uniform changes in RBC transfusion practices across all ICU settings.
• Higher-volume ICUs demonstrated better adoption of restrictive transfusion strategies post-guideline compared to lower-volume ICUs.
• Translating evidence into practice for restrictive RBC transfusion thresholds may be variable depending on hospital characteristics.