Journal of general internal medicine · 2025
Red Cell Transfusion in General Medicine Patients at Teaching and Non-teaching Hospitals: A Retrospective Cohort Analysis.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Raza Sheharyar, Risk Malcolm, Loeffler Anne, Verma Amol A, Razak Fahad, Arnold Donald, Fergusson Dean, Ryan Sarah, Relke Nicole, Gabarin Nadia, Li Na, Nguyen Rachel, Tyryshkin Kathrin, Roberts Surain, Callum Jeannie, GADGET Research Team
Аннотация
BACKGROUND: Red blood cell transfusion is a well-studied intervention with numerous randomized trials to guide management, yet practice remains highly variable.
OBJECTIVE: In this study, we explored hospital and patient factors influencing red cell transfusion in a large multi-center database of hospitalized patients.
DESIGN: Retrospective analysis PARTICIPANTS: All adults admitted at hospitals in the GEMINI database-a multi-center inpatient database in Ontario, Canada, between December 2016 and June 2022.
MAIN MEASURES: The pre-specified primary analysis compared average treatment effect (ATE) of hemoglobin value on transfusion probability in general internal medicine (GIM) patients by hospital type (teaching or non-teaching) and selected medical diagnoses.
KEY RESULTS: The primary analysis cohort consisted of 525,510 GIM patients from 24 hospitals. The overall cohort had a 24-h transfusion probability of 79.2% in the < 6.0 g/dL range, 76.2% in the 6.0-6.9 g/dL range, 18.2% in the 7.0-7.9 g/dL range, and 1.1% in the > 8.0 g/dL range. In comparative primary analyses based on medical diagnosis, transfusion probability was higher in the 6.0-6.9 g/dL range for patients presenting to non-teaching hospitals with sickle cell disease (28.7% vs 11.9%, ATE 16.8%, 95% CI 12.6-21.0, p < 0.001), cardiac disease (80.5% vs 75.8%, ATE 4.7%, 95% CI 3.4-5.9, p < 0.001), and gastrointestinal bleeding (87.8% vs 86.1%, ATE 1.8%, 95% CI 0.9-2.6, p < 0.003), and similar for patients with iron deficiency (77% vs 76.5%, ATE 0.5%, 95% CI 0.6-1.6, p = 0.39).
CONCLUSIONS: In this longitudinal cohort study, GIM patients with sickle cell and cardiac disease faced substantially different probabilities of red cell transfusion at teaching and non-teaching hospitals.
OBJECTIVE: In this study, we explored hospital and patient factors influencing red cell transfusion in a large multi-center database of hospitalized patients.
DESIGN: Retrospective analysis PARTICIPANTS: All adults admitted at hospitals in the GEMINI database-a multi-center inpatient database in Ontario, Canada, between December 2016 and June 2022.
MAIN MEASURES: The pre-specified primary analysis compared average treatment effect (ATE) of hemoglobin value on transfusion probability in general internal medicine (GIM) patients by hospital type (teaching or non-teaching) and selected medical diagnoses.
KEY RESULTS: The primary analysis cohort consisted of 525,510 GIM patients from 24 hospitals. The overall cohort had a 24-h transfusion probability of 79.2% in the < 6.0 g/dL range, 76.2% in the 6.0-6.9 g/dL range, 18.2% in the 7.0-7.9 g/dL range, and 1.1% in the > 8.0 g/dL range. In comparative primary analyses based on medical diagnosis, transfusion probability was higher in the 6.0-6.9 g/dL range for patients presenting to non-teaching hospitals with sickle cell disease (28.7% vs 11.9%, ATE 16.8%, 95% CI 12.6-21.0, p < 0.001), cardiac disease (80.5% vs 75.8%, ATE 4.7%, 95% CI 3.4-5.9, p < 0.001), and gastrointestinal bleeding (87.8% vs 86.1%, ATE 1.8%, 95% CI 0.9-2.6, p < 0.003), and similar for patients with iron deficiency (77% vs 76.5%, ATE 0.5%, 95% CI 0.6-1.6, p = 0.39).
CONCLUSIONS: In this longitudinal cohort study, GIM patients with sickle cell and cardiac disease faced substantially different probabilities of red cell transfusion at teaching and non-teaching hospitals.