Variation in Blood Transfusion and Coagulation Management in Traumatic Brain Injury at the Intensive Care Unit: A Survey in 66 Neurotrauma Centers Participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Study

Our aim was to describe current approaches and to quantify variability between European intensive care units (ICU)s in patients with TBI.Therefore, we conducted a provider profiling survey as part of the 'Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury' (CENTER-TBI) study.The ICU Questionnaire was sent to 68 centers from 20 countries across Europe and Israel.For this study, we used ICU questions focused on 1) hemoglobin target level (Hb-TL), 2) coagulation management, and 3) deep venous thromboembolism (DVT) prophylaxis.Seventy-eight participants, mostly intensivists and neurosurgeons of 66 centers completed the ICU questionnaire.For ICUpatients, half of the centers (N=34; 52%) had a defined Hb-TL in their protocol.For patients with TBI, 26 centers (41%) indicated a Hb-TL between 70 and 90 g/l and 38 centers (59%) above 90 g/l.To treat trauma related hemostatic abnormalities the use of fresh frozen plasma (N=48; 73%) or platelets (N=34; 52%) was most often reported, followed by the supplementation of vitamin K (N=26; 39%).Most centers reported using DVT prophylaxis with anticoagulants frequently or always (N=62; 94%).In the absence of hemorrhagic brain lesions, 14 centers (21%) delayed DVT prophylaxis until 72 hours after trauma.If hemorrhagic brain lesions were present, the number of centers delaying DVT prophylaxis for 72 hours increased to 29 (46%).Overall, a lack of consensus exists between European ICUs on blood transfusion and coagulation management.The results provide a baseline for the CENTER-TBI study and the large between-center variation indicates multiple opportunities for comparative effectiveness research.