Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU).

PURPOSE: Thrombocytopenia (platelet count < 150 × 109/L) is common in intensive care unit (ICU) patients and is likely associated with worse outcomes. In this study we present international contemporary data on thrombocytopenia in ICU patients. METHODS: We conducted a prospective cohort study in adult ICU patients in 52 ICUs across 10 countries. We assessed frequencies of thrombocytopenia, use of platelet transfusions and clinical outcomes including mortality. We evaluated pre-selected potential risk factors for the development of thrombocytopenia during ICU stay and associations between thrombocytopenia at ICU admission and 90-day mortality using pre-specified logistic regression analyses. RESULTS: We analysed 1166 ICU patients; the median age was 63 years and 39.5% were female. Overall, 43.2% (95% confidence interval (CI) 40.4-46.1) had thrombocytopenia; 23.4% (20-26) had thrombocytopenia at ICU admission, and 19.8% (17.6-22.2) developed thrombocytopenia during their ICU stay. Absence of acquired immune deficiency syndrome (AIDS), non-cancer-related immune deficiency, liver failure, male sex, septic shock, and bleeding at ICU admission were associated with the development of thrombocytopenia during ICU stay. Among patients with thrombocytopenia, 22.6% received platelet transfusion(s), and 64.3% of in-ICU transfusions were prophylactic. Patients with thrombocytopenia had higher occurrences of bleeding and death, fewer days alive without the use of life-support, and fewer days alive and out of hospital. Thrombocytopenia at ICU admission was associated with 90-day mortality (adjusted odds ratio 1.7; 95% CI 1.19-2.42). CONCLUSION: Thrombocytopenia occurred in 43% of critically ill patients and was associated with worse outcomes including increased mortality. Platelet transfusions were given to 23% of patients with thrombocytopenia and most were prophylactic.

Age, cognitive load, and multimodal effects on driver response to directional warning.

Inattention can be considered a primary cause of vehicular accidents or crashes, and in-car warning signals are applied to alert the driver to take action even in automated vehicles. Because of age related decline of the older driver's abilities, in-car warning signals may need adjustment to the older driver. We therefore investigated the effects of uni-, bi- and trimodal directional warnings (i.e., light, sound, vibration) on young and older drivers' responses in a driving simulator. A young group of 15 drivers (20-25 years of age) and an older group of 16 drivers (65-79 years of age) participated. In the simulations, warning signal was presented at the left, the center, or the right in front of the participant. With a warning at the left, the center, and the right the correct response was to steer to the right, brake, and steer to the left, respectively. The main results showed the older drivers' responses were slower for each type of warning compared with the young drivers' responses. Overall, the responses were slower with an added cognitively loading task. The only multimodal type of warning inducing overall faster response than its constituent warning types was the vibration-sound, and only for the older drivers. Additionally, with the groups' responses collapsed, such a true multimodal effect on response time also showed for the center vibration-sound warning (i.e., braking response). The only multimodal warning showing clear reduction in response errors compared with its constituent warning types was the vibration-sound for the older drivers during extra cognitive load. The main conclusion is that older drivers can benefit from bimodal warning, as compared with unimodal, in terms of faster and more accurate response. The potential superiority of trimodal warning is nevertheless argued.