The following is a summary of “Hospital variation in adoption of balanced transfusion practices among injured patients requiring blood transfusions,” published in the July 2024 issue of Surgery by Nasca et al.
This study aimed to assess the variability in hospital adoption of balanced transfusion practices following the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) guidelines. Researchers hypothesized that the adoption rates of balanced transfusion would be low and exhibit significant variability among hospitals, even after adjusting for patient, injury, and hospital characteristics.
This observational cohort study included injured adult patients (≥16 years) treated at Trauma Quality Improvement Program hospitals from 2016 to 2021. The inclusion criteria encompassed patients who were hypotensive and were receiving at least one transfusion of packed red blood cells, fresh frozen plasma, platelets, or cryoprecipitate. Balanced transfusion was defined as maintaining a plasma-to-packed red blood cells or platelets-to-packed red blood cells ratio, or using whole blood within four hours. Hierarchical multivariable logistic regression was used to quantify the residual hospital-level variability in balanced transfusion rates, adjusting for patient and hospital characteristics.
Out of 172,457 injured patients who received transfusions, 30,386 (17.6%) underwent balanced transfusion. The patient-level balanced transfusion rates were 11% in 2016, increasing to 14.0% in 2019, and then significantly rising to 24.0% in 2020 and 25.9% in 2021 with the inclusion of whole blood transfusions. Approximately 26% of the variability in balanced transfusion rates was attributable to the hospital. Verified level I hospitals had 2.09 times higher adjusted odds of balanced transfusion (95% CI 1.88–2.21) compared to nonverified hospitals. University teaching hospitals exhibited 1.29 times higher adjusted odds of balanced transfusion (95% CI 1.08–1.54) compared to community hospitals. Overall, 150 (23.5%) hospitals were high outliers (high performing) in balanced transfusion adoption, while 124 (19.4%) hospitals were low outliers.
There is significant variability in hospital adoption of balanced transfusion practices. Despite improvements over time, particularly with the inclusion of whole blood transfusions, a considerable proportion of variability remains attributable to hospital-level factors. This underscores the need for targeted interventions to promote the adoption of balanced transfusion practices across diverse hospital settings.
Source: sciencedirect.com/science/article/abs/pii/S0039606024004604
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