• Jilske A Huijben, Mathieu van der Jagt, Maryse C Cnossen, KruipMarieke J H AMJHADepartment of Hematology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands., Iain K Haitsma, Nino Stocchetti, MaasAndrew I RAIRDepartment of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium., David K Menon, Ari Ercole, Marc Maegele, Simon J Stanworth, Giuseppe Citerio, Suzanne Polinder, Ewout W Steyerberg, Hester F Lingsma, and CENTER-TBI Investigators and Participants.
• Center for Medical Decision Sciences, Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands.
• J. Neurotrauma. 2018 Jan 15; 35 (2): 323-332.

AbstractOur aim was to describe current approaches and to quantify variability between European intensive care units (ICUs) in patients with traumatic brain injury (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 ICU-patients, half of the centers (N = 34; 52%) had a defined Hb-TL in their protocol. For patients with TBI, 26 centers (41%) indicated an 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 h after trauma. If hemorrhagic brain lesions were present, the number of centers delaying DVT prophylaxis for 72 h 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.

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