Red Cell Transfusion During Pediatric Intensive Care: A 28-Day Point Prevalence Study in Three European Countries in 2023.

Objectives: To describe the prevalence of RBC transfusion in children admitted to PICUs in three European countries and to determine hemoglobin threshold, triggers, and outcomes for transfusions.

Design: International 4-week point prevalence study in 2023.

Setting: Forty-four PICUs across Spain, the United Kingdom, and Italy.

Patients: PICU patients 1 month to 17 years old receiving RBC transfusion.

Interventions: None.

Measurements And Main Results: During four prespecified 7-day blocks (from March 2023 to July 2023), 348 of 2713 patients (12.8%) received at least one RBC transfusion, accounting for 527 transfusions. The proportion of patients receiving RBC transfusion in Italy, the United Kingdom, and Spain was 17.3% (66/382), 13.9% (166/1195), and 10.2% (116/1136), respectively. The primary indication for transfusion in the 527 transfusion events was hemoglobin level (54.6%), followed by bleeding (10.6%), cardiovascular instability (10.5%), and extracorporeal support (10.1%). In 45.1% of RBC transfusions, there was no other physiologic trigger apart from hemoglobin. The median (interquartile range [IQR]) hemoglobin level before transfusion was 8.3 g/dL (IQR, 7.2-9.9 g/dL), with median values varying significantly among Spain, the United Kingdom, and Italy, respectively, 7.8 vs. 8.6 vs. 8.9 g/dL (p < 0.001). When excluding cardiac patients, overall median hemoglobin threshold was 7.4 g/dL (IQR, 6.8-8.6 g/dL) and was comparable across the three countries (p > 0.05). The overall 28-day PICU mortality in 348 patients receiving transfusions was 10.7%. The number of transfusions was associated with mortality, even after adjusting for reason for admission and admission Pediatric Index of Mortality score.

Conclusions: In 44 European PICUs in 28 days during 2023, 12.8% of critically ill children received one or more RBC transfusions during their PICU stay. Hemoglobin level was the primary determinant for transfusion, often exceeding the recommended 7.0 g/dL threshold. Other clinical triggers are rarely considered. Defining hemoglobin thresholds and adopting a goal-directed transfusion strategies may optimize clinical transfusion practices.