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Education, Research, and Quality Improvement |

Blood Transfusion - Who Knows What to Do? A Survey of Medical House-Staff

Ricardo Restrepo*, MD; Michael Baram, MD; Paul Marik, MD
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Thomas Jefferson University, Philadelphia, PA


Chest. 2012;142(4_MeetingAbstracts):537A. doi:10.1378/chest.1388615
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Abstract

SESSION TYPE: Education and Teaching in Critical Care Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: The objective of this study was to determine if house officers understand the current evidence based practices for transfusion of blood products and the tendency of transfusion practices of house officers in teaching institutions in US.

METHODS: Eighty-three house officers from six accredited United States (US) academic medical training programs were asked to complete a survey regarding the principals of transfusions (eight questions) and the appropriateness or inappropriateness of blood transfusion by rating (inappropriate, uncertain, appropriate) 10 clinical scenarios derived from the International Consensus Conference on Transfusion Outcomes (ICCTO) in which there was 100% agreement between the panelists. The study was approved by the Institutional Review Board of the coordinating center.

RESULTS: On average the group scored poorly regardless of the level of training with an average score of 61 %. Only seven (9%) subjects were correct in all scenarios. When the questions were categorized according the principals of transfusion and case based scenarios, the score for correct answers were 55 % and 69 % respectively. When the group was divided by year of training, fellows did slightly better scoring 68 % vs 56 % for residents (NS). Clinical scenarios with a hemoglobin (Hb) > 10 g/dl had the correct answer chosen 90% of the time while for cases with a Hb 8.0 - 9.9 g/dl a correct answer was chosen 60% of the time (NS). When the age of the patient presented in the clinical question was analyzed, we found that if patients were younger than 61 years the subjects answered correctly to 82% of the time compared to 59 % when the case included patients 61 years or older (NS). The scores did not differ between centers, suggesting that this is a nationwide problem.

CONCLUSIONS: Indications for RBC transfusions are not well understood by trainees. Although the literature offers many resources, there is no consensus that defines all scenarios, but a few basic guidelines do exist that multi-disciplinary experts do agree on. This information must be delivered to the house officers who are taking care of hospitalized patients.

CLINICAL IMPLICATIONS: Blood transfusions have become one of the most common interventions performed worldwide in modern health care. There is growing evidence suggesting that Red Blood Cell transfusion carries a limited benefit and may increase the incidence to unfavorable outcomes. The need for improvements in transfusion medicine education for residents and fellows has been recognized.

DISCLOSURE: The following authors have nothing to disclose: Ricardo Restrepo, MIchael Baram, Paul Marik

No Product/Research Disclosure Information

Thomas Jefferson University, Philadelphia, PA

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