Sanne de Bruin

34 Chapter 2 ICU. Visco-elastic tests are less common, only in the minority of the hospitals rotational thromboelastometry (ROTEM, 31%) or thromboelastography (TEG, 18%) are available as diagnostic tool. Guideline Among the respondents, 29% have an ICU specific and 53% a (not ICU specific) trans- fusion guideline in their ICU. The availability of a guideline has limited effect on the transfusion practice. Only for the general ICU population the presence of a (not ICU) spe- cific transfusion guideline was associated with a lower transfusion threshold (p=0.028, Additional file 1 table S3). For other ICU subpopulations, this association with RCC trans- fusion practice was not present (Additional file 1 table S2 and S3). Also, for platelet and plasma transfusion no association was found between the presence of a guideline and transfusion practice (Additional file 1 table S5 and S6). Background specialty To investigate whether the base specialty influences transfusion practices, only the groups anaesthesiology (69% of the respondents) and internal medicine (20% of the respondents) were sufficiently present to perform additional testing. For RCC, PC and plasma transfusion, an association was found between base specialty and transfusion practice. Overall, the base specialty anaesthesiology was associated with a more liberal transfusion practice compared to internal medicine. With the exception of patients with ACS and patients on ECMO, physicians with the base specialty anaesthesiology said to transfuse all subpopulations at significantly higher Hb thresholds. Furthermore, anaes- thesiologists more often report the use of physiological triggers in addition to Hb levels in their decision to transfuse than internal medicine physicians (p =0.02, see Additional file 1 table S4). Also, thrombocytopenic patients are transfused at higher platelet counts prior CVC placement (p=0.002) and prior to tracheotomy (p=0.007, Additional file 1 table S7) when treated by a physician with the base specialty anaesthesiology. For plasma transfusion, only in prophylactically transfusions a different practice was observed between these two base specialties. Physicians with base specialty anaesthesiology transfuse plasma prophylactically more frequently (Additional file 1, Figure S3). Regional differences In all world regions, a median Hb threshold of 7g/dL (7.7) was reported for the general ICU population. For different subpopulations, a greater variety was reported, especially in patients with ACS, traumatic brain injury, and patients receiving ECMO (Additional file 1al figure S2). In platelet transfusion some alignment exists for prophylactic platelet transfusion with a median applied platelet count prophylactically between 15 and 20