评估加纳一家三级医院创伤患者输血的适宜性：明确使用稀缺资源的时候到了。
Assessing the appropriateness of blood transfusion among injured patients at a Ghanaian tertiary hospital: Time for clarity on the use of a scarce resource.
机构信息
Department of Surgery; School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Standford Children's Health, Palo Alto, California, USA.
出版信息
Injury. 2021 May;52(5):1164-1169. doi: 10.1016/j.injury.2021.01.028. Epub 2021 Jan 21.
INTRODUCTION
Hemorrhage is an important cause of preventable injury-related death. Many low- and middle-income country (LMIC) patients do not have timely access to safe blood. We sought to determine the degree of appropriateness of blood transfusion among patients with injuries requiring surgical intervention at presentation to a tertiary hospital in Ghana.
METHODS
We performed a retrospective review of such patients presenting to Komfo Anokye Teaching Hospital (KATH), from January 2015 to December 2016. Patients' hemoglobin levels at presentation were determined as the first record of hemoglobin after presentation and their receipt of blood transfusion was determined by explicit documentation in the chart. We defined appropriate blood transfusion practice as patients receiving transfusion when hemoglobin was equal or below a threshold, or patients not being transfused when hemoglobin was above the threshold. We considered both restrictive (hemoglobin ≤7 g/dL) and liberal (hemoglobin ≤10 g/dL) transfusion thresholds.
RESULTS
There were 1,408 patients who presented to KATH with injuries that met inclusion criteria. Two hundred and ninety two (292) patients were excluded because of missing hemoglobin information. Four hundred and fifty eight (458;41%) patients received blood transfusion. Transfused patients had a higher mean age (38 vs 35 years) and were less likely to be male (62% vs 71%). Transfused patients underwent more external fixation procedures (28% vs 19%), trauma amputations (5% vs 1%) and trauma laparotomies (3% vs 1%). At a restrictive transfusion threshold (hemoglobin ≤7 g/dL), 20% of patients who needed a transfusion did not receive one and 39% of patients who did not need a transfusion received one. At a liberal threshold (hemoglobin ≤10 g/dL), 33% of patients who needed a transfusion did not receive one and 30% of patients who did not need a transfusion received one. Blood transfusion practice was inappropriate in 31%-39% of all patients.
CONCLUSION
Our data suggest that clearer guidelines for blood transfusion among emergency surgery patients are needed in Ghana and similar LMICs to avoid inappropriate use of blood as a scarce resource.
简介
出血是可预防的与损伤相关死亡的一个重要原因。许多中低收入国家（LMIC）的患者无法及时获得安全的血液。我们旨在确定在加纳一家三级医院就诊的需要手术干预的损伤患者的输血是否适当。
方法
我们对 2015 年 1 月至 2016 年 12 月期间在科福·安科耶教学医院（KATH）就诊的此类患者进行了回顾性研究。患者在就诊时的血红蛋白水平被定义为就诊后的首次血红蛋白记录，他们是否接受输血则通过图表中的明确记录来确定。我们将适当的输血实践定义为血红蛋白等于或低于阈值时接受输血，或血红蛋白高于阈值时不输血。我们考虑了限制性（血红蛋白≤7g/dL）和宽松性（血红蛋白≤10g/dL）输血阈值。
结果
共有 1408 名因损伤就诊的患者符合纳入标准，但有 292 名患者因血红蛋白信息缺失而被排除。458 名患者（41%）接受了输血。接受输血的患者年龄更高（38 岁比 35 岁），且男性比例较低（62%比 71%）。接受输血的患者接受更多的外固定术（28%比 19%）、创伤截肢术（5%比 1%）和创伤剖腹术（3%比 1%）。在限制性输血阈值（血红蛋白≤7g/dL）下，20%需要输血的患者未接受输血，而 39%不需要输血的患者接受了输血。在宽松性输血阈值（血红蛋白≤10g/dL）下，33%需要输血的患者未接受输血，而 30%不需要输血的患者接受了输血。在所有患者中，31%-39%的输血是不适当的。
结论
我们的数据表明，加纳和类似的中低收入国家需要制定更明确的急诊手术患者输血指南，以避免将血液作为稀缺资源的不当使用。
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