Red blood cell transfusions for emergency department patients with gastrointestinal bleeding within an integrated health system.
Am J Emerg Med
; 38(4): 746-753, 2020 04.
Article
em En
| MEDLINE
| ID: mdl-31208843
ABSTRACT
STUDY OBJECTIVE:
To assess trends over time in red blood cell (RBC) transfusion practice among emergency department (ED) patients with gastrointestinal (GI) bleeding within an integrated healthcare system, inclusive of 21 EDs.METHODS:
Retrospective cohort of ED patients diagnosed with GI bleeding between July 1st, 2012 and September 30th, 2016. The primary outcome was receipt of an RBC transfusion in the ED. Secondary outcomes included 90-day rates of RBC transfusion, repeat ED visits, rehospitalization, and all-cause mortality. Logistic regression was used to obtain confounder-adjusted outcome rates.RESULTS:
A total of 24,868 unique patient encounters were used for the primary analysis. The median hemoglobin level in the ED prior to RBC transfusion decreased from 7.5â¯g/dl to 6.9â¯g/dl in the first versus last twelve months of the study period (pâ¯<â¯0.0001). A small trend was observed in the overall adjusted rate of ED RBC transfusion (absolute quarterly change of -0.1%, R2â¯=â¯0.18, pâ¯=â¯0.0001) largely attributable to the subgroup of patients with hemoglobin nadirs between 7.0 and 9.9â¯g/dl (absolute quarterly change of -0.4%, R2â¯=â¯0.38, pâ¯<â¯0.0001). Rates of RBC transfusions through 90â¯days likewise decreased (absolute quarterly change of -0.4%, R2â¯=â¯0.85, pâ¯<â¯0.0001) with stable to decreased corresponding rates of repeat ED visits, rehospitalizations and mortality.CONCLUSION:
Rates of ED RBC transfusion decreased over time among patients with GI bleeding, particularly in those with hemoglobin nadirs between 7.0 and 9.9â¯g/dl. These findings suggest that ED providers are willing to adopt evidence-based restrictive RBC transfusion recommendations for patients with GI bleeding.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Transfusão de Eritrócitos
/
Hemorragia Gastrointestinal
Tipo de estudo:
Etiology_studies
/
Guideline
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
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Female
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Humans
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Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article