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 7.5 g/dl
to 6.9 g/dl in the first versus last twelve months of the study period (p < 0.0001). A small trend was observed in the overall adjusted rate of ED RBC transfusion
(absolute quarterly change of −0.1%, R2 = 0.18, p = 0.0001) largely attributable to the subgroup of patients with hemoglobin nadirs
between 7.0 and 9.9 g/dl (absolute quarterly change of −0.4%, R2 = 0.38, p < 0.0001). Rates of RBC transfusions through 90 days likewise decreased (absolute
quarterly change of −0.4%, R2 = 0.85, p < 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 9.9 g/dl. These findings suggest that
ED providers are willing to adopt evidence-based restrictive RBC transfusion recommendations
for patients with GI bleeding.
Abbreviations:
CI (confidence interval), ED (emergency department), EHR (electronic health record), GI (gastrointestinal), INR (international normalized ratio), IQR (interquartile range), KPNC (Kaiser Permanente Northern California), RBC (red blood cell)Keywords
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Article Info
Publication History
Published online: June 10, 2019
Accepted:
June 9,
2019
Received in revised form:
June 6,
2019
Received:
May 15,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
