title: Can old dogs learn new "transfusion requirements in critical care": a survey of packed red blood cell transfusion practices among members of The American Association for the Surgery of Trauma.
abstract: BACKGROUND
  The objective of this study was to characterize variations in packed red blood cell (PRBC) transfusion practices in critically ill patients and to identify which factors influence such practices. We hypothesized that significant variation in transfusion triggers exists among acute care surgeons.
  
  
  METHODS
  A survey of PRBC transfusion practices was administered to the American Association for the Surgery of Trauma members. The scenarios examined hemoglobin thresholds for which participants would transfuse PRBCs.
  
  
  RESULTS
  A hemoglobin threshold of less than or equal to 7 g/dL was adopted by 45% of respondents in gastrointestinal bleeding, 75% in penetrating trauma, 66% in sepsis, and 62% in blunt trauma. Acute care surgeons modified their transfusion trigger significantly in the majority of the modifications of these scenarios, often inappropriately so.
  
  
  CONCLUSIONS
  This study documents continued evidence-practice gaps and wide variations in the PRBC transfusion practices of acute care surgeons. Numerous clinical factors altered such patterns despite a lack of supporting evidence (for or against).
authors.affiliation: Department of Surgery, Brookdale University Hospital and Medical Center, Brookdale Plaza, Brooklyn, NY 11212, USA.
authors.forename: Vasiliy
authors.initials: V
authors.lastname: Sim
authors.affiliation: Department of Surgery, UTHealth, 7000 Fannin Street, Houston, TX 77030, USA.
authors.forename: Lillian S
authors.initials: LS
authors.lastname: Kao
authors.affiliation: Department of Pathology, New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Jacobson
authors.affiliation: Department of Pathology, New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA.
authors.forename: Spiros
authors.initials: S
authors.lastname: Frangos
authors.affiliation: Department of Surgery, Queen Mary University of London, Mile End Road, London E1 4NS, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Brundage
authors.affiliation: Department of Pathology, New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA.
authors.forename: Chad T
authors.initials: CT
authors.lastname: Wilson
authors.affiliation: Department of Pathology, New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA.
authors.forename: Ron
authors.initials: R
authors.lastname: Simon
authors.affiliation: Department of Pathology, New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA.
authors.forename: Nina E
authors.initials: NE
authors.lastname: Glass
authors.affiliation: Department of Pathology, New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA.
authors.forename: H Leon
authors.initials: HL
authors.lastname: Pachter
authors.affiliation: Department of Pathology, New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA. Electronic address: srtodd@nyumc.org.
authors.forename: S Rob
authors.initials: SR
authors.lastname: Todd
mesh_terms: D002983:Clinical Competence; D017707:Erythrocyte Transfusion / Q000592:standards*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012955:Societies, Medical; D014194:Traumatology / Q000193:education; D014481:United States
keywords: Critical illness; Hemoglobin; Red blood cell transfusion; Survey methodology