PURPOSE: The SAFE (Saline versus Albumin Fluid Resuscitation Evaluation) trial N Engl J Med May 27, 2004 was a landmark study that reinforced previous findings of no benefit for albumin vs. saline in volume replacement for critically ill patients . This study aims to evaluate the impact of this trial on the prescription of albumin by physicians.
METHODS: At a mid-sized university teaching hospital we searched our electronic database for all albumin orders from January 1999 - July 2006. We analyzed the rates of using Albumin before (2000–2004) and after (2005–2006) publication of the SAFE Trial. Process control charts analysis was used to study patterns of albumin orders over six years period. Subgroup analysis was performed for medical and surgical specialties.Significant was defined as P value <0.05 and all tests were two sided.
RESULTS: Of 73344 discharges, 3189 had received albumin (5% or 25% concentrations) yielding a rate of 4%. We analyzed the rates before (2000–2004) and after (2005–2006) publication of the SAFE Trial. No significant change was identified (4.69% versus 3.94%; p =0.379).Repeat analysis by process control charts confirmed no change in overall use of albumin by our physicians. Sub group analysis revealed lower trend for albumin orders for medical specialties and no significance change for surgical specialties (11.15 ± 3.39 before and 7.81 ± 2.8 after p<0.0001 for medical; 23.23 ±4.8 before and 23.82 ±4.88 p=0.599).
CONCLUSION: Despite the findings of the SAFE Trial, physician's behavior has not changed, particularly within our surgical subspecialties.
CLINICAL IMPLICATIONS: Change due to landmark publications are slow to be adapted into everyday practice, and are variable across specialties. Causes of this variation should be studied in order to improve patient selection for experimental treatments, and to improve standardization in medical practice.
DISCLOSURE: Mohammad Jarbou, No Financial Disclosure Information; No Product/Research Disclosure Information