Systematic criteria for type and screen based on procedure's probability of erythrocyte transfusion

Anesthesiology
Franklin DexterRichard H Epstein

Abstract

At many hospitals, the type and screen decision is guided by the hospital's maximum surgical blood order schedule, a document that includes for each scheduled (elective) surgical procedure a recommendation of whether a preoperative type and screen be performed. There is substantial heterogeneity in the scientific literature for how that decision should be made. Anesthesia information management system data were retrieved from the 160,207 scheduled noncardiac cases in adults of 1,253 procedures at a hospital. Neither assuming a Poisson distribution of mean erythrocyte units transfused, nor grouping rare procedures into larger groups based on their anesthesia Current Procedural Terminology code, was reliable. In contrast, procedures could be defined to have minimal estimated blood loss (less than 50 ml) based on low incidence of transfusion and low incidence of the hemoglobin being checked preoperatively. Among these procedures, when the lower 95% confidence limit for erythrocyte transfusion was less than 5%, type and screen was shown to be unnecessary. The method was useful based on including multiple differences from the hospital's maximum surgical blood order schedule and clinicians' test ordering (greater than or equal to 29%...Continue Reading

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Citations

Jan 15, 2014·Anesthesia and Analgesia·Charles H BrownSteven M Frank
Dec 24, 2013·Journal of the American Medical Informatics Association : JAMIA·Jorge A GálvezMohamed A Rehman
Jun 8, 2013·Obstetrics and Gynecology·Andrew J DillaMark H Yazer
Dec 19, 2015·Anesthesia and Analgesia·Franklin DexterBradley J Hindman
Sep 24, 2015·British Journal of Anaesthesia·M A LevinD L Reich
Aug 21, 2013·Paediatric Anaesthesia·Allison M FernándezEugenie S Heitmiller
Aug 20, 2015·Anesthesia and Analgesia·Jorge A GálvezMohamed A Rehman
Feb 9, 2012·Anesthesiology·David L Reich, Melissa S Pessin
May 8, 2013·Anesthesiology·Timothy T Houle, Dana P Turner
Mar 1, 2015·Seminars in Cardiothoracic and Vascular Anesthesia·Kelly Graham UralHeather Scuderi-Porter
Mar 30, 2018·Anesthesia and Analgesia·Richard H Epstein, Franklin Dexter
Jun 12, 2018·Current Opinion in Obstetrics & Gynecology·Jessica ShieldsKimberly Kho
Sep 5, 2019·Journal of Clinical Medicine·Min Seob KimHo-Geol Ryu

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