Document Detail

A clinical prediction tool to estimate the number of units of red blood cells needed in primary elective coronary artery bypass surgery.
MedLine Citation:
PMID:  20529005     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Red blood cell (RBC) transfusion is common during cardiac surgical procedures. Empiric crossmatching, without attempting to estimate individual transfusion requirements is typical. We hypothesized that a clinical prediction tool could be developed to estimate the number of units of RBCs needed for coronary artery bypass grafting (CABG) surgery.
STUDY DESIGN AND METHODS: With institutional review board approval, detailed demographic, risk factor, and transfusion data of primary elective CABG procedures (n=5887) from September 1, 1993, to June 20, 2002, were studied and the data set was divided into development and validation subgroups. Multivariable ordinal logistic regression was used to develop and validate transfusion risk factors, assign them a relative weight, and create a model to stratify patients into groups depending on predicted need for 0, 2, 4, or more than 4 RBC units. The model was compared with current standard practice of crossmatching 4 RBC units in terms of observed blood product usage over the study period.
RESULTS: Demographic and transfusion risk factor variables in the development (n=3876) and validation (n=2011) data sets were similar. The predictive value of the model was good for the development and validation groups, with a c-index of 0.79 and 0.78, respectively. Applying the predictive model reduced the number of crossmatches by 30% without underproviding RBC units and increased the percentage of patients crossmatched exactly for the required number of units from 11% to 21%.
CONCLUSIONS: Predictive factors for RBC transfusion were identified and used to construct a clinical tool to conserve blood bank resources without increasing patient risk.
Ian Welsby; Jennifer Crow; Nicholas Bandarenko; George Lappas; Barbara Phillips-Bute; Mark Stafford-Smith
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Transfusion     Volume:  50     ISSN:  1537-2995     ISO Abbreviation:  Transfusion     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-12-24     Completed Date:  2011-01-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0417360     Medline TA:  Transfusion     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2337-43     Citation Subset:  IM    
Copyright Information:
© 2010 American Association of Blood Banks.
Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.
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MeSH Terms
Blood Banks / statistics & numerical data,  utilization
Blood Loss, Surgical / statistics & numerical data*
Coronary Artery Bypass / methods*,  statistics & numerical data
Databases, Factual
Education, Medical, Continuing
Erythrocyte Transfusion / statistics & numerical data*,  utilization
Models, Statistical*
Predictive Value of Tests
Reproducibility of Results
Risk Factors
Surgical Procedures, Elective / methods*,  statistics & numerical data

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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