Factors influencing plasma transfusion practices in paediatric intensive care units around the world.
OBJECTIVE
Plasma transfusions are a frequent treatment worldwide, but many studies have reported a wide variation in the indications to transfuse. Recently, an international paediatric study also showed wide variation in frequency in the use of plasma transfusions: 25% of the centres transfused plasma to >5% of their patients, whereas another 25% transfused plasma to <1% of their patients. The objective of this study was to explore the factors associated with different plasma transfusion practices in these centres.


METHODS
Online survey sent to the local investigators of the 101 participating centres, in February 2016. Four areas were explored: beliefs regarding plasma transfusion, patients' case-mix in each unit, unit's characteristics, and local blood product transfusion policies and processes.


RESULTS
The response rate was 82% (83/101). 43% of the respondents believed that plasma transfusions can arrest bleeding, whereas 27% believe that plasma transfusion can prevent bleeding. Centres with the highest plasma transfusion rate were more likely to think that hypovolaemia and mildly abnormal coagulation tests are appropriate indications for plasma transfusions (P = 0·02 and P = 0·04, respectively). Case-mix, centre characteristics or local transfusion services were not identified as significant relevant factors.


CONCLUSIONS
Factors influencing plasma transfusion practices reflect beliefs about indications and the efficacy of transfusion in the prevention and management of bleeding as well as effects on coagulation tests. Educational and other initiatives to target these beliefs should be the focus of research.
Pediatric Intensive Care Unit, Geneva University Hospital, Geneva, Switzerland.|Univ. Lille, EA 2694 - Santé Publique : épidémiologie et qualité des soins, Lille, France.
O
O
Karam
Univ. Lille, EA 2694 - Santé Publique : épidémiologie et qualité des soins, Lille, France.|Pediatric Intensive Care Unit, CHC Liège, Liège, Belgium.
P
P
Demaret
Univ. Lille, EA 2694 - Santé Publique : épidémiologie et qualité des soins, Lille, France.|CHU Lille, Service de Biostatistique, Lille, France.
A
A
Duhamel
Pediatric Intensive Care Unit, Oxford University Hospitals, Oxford, UK.
A
A
Shefler
Division of Critical Care, Department of Pediatrics, Washington University in St Louis, St. Louis, MO, USA.
P C
PC
Spinella
Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, QC, Canada.
M
M
Tucci
Univ. Lille, EA 2694 - Santé Publique : épidémiologie et qualité des soins, Lille, France.|CHU Lille, Service de réanimation pédiatrique, Lille, France.
S
S
Leteurtre
NHS Blood and Transplant/Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.|Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
S J
SJ
Stanworth
D000328:Adult; D016913:Blood Component Transfusion / Q000706:statistics & numerical data; D005260:Female; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D015278:Intensive Care Units, Pediatric; D019934:International Normalized Ratio; D008297:Male; D010314:Partial Thromboplastin Time; D010820:Physicians / Q000523:psychology; D011795:Surveys and Questionnaires
blood component transfusion; child; critical illness; plasma