Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY.
Department of Biomedical Engineering, University of Rochester, Rochester, NY.
Pediatr Crit Care Med. 2023 Nov 1;24(11):e520-e530. doi: 10.1097/PCC.0000000000003287. Epub 2023 May 23.
Frequent diagnostic blood sampling contributes to anemia among critically ill children. Reducing duplicative hemoglobin testing while maintaining clinical accuracy can improve patient care efficacy. The objective of this study was to determine the analytical and clinical accuracy of simultaneously acquired hemoglobin measurements with different methods.
Retrospective cohort study.
Two U.S. children's hospitals.
Children (< 18 yr old) admitted to the PICU.
None.
We identified hemoglobin results from complete blood count (CBC) panels paired with blood gas (BG) panels and point-of-care (POC) devices. We estimated analytic accuracy by comparing hemoglobin distributions, correlation coefficients, and Bland-Altman bias. We measured clinical accuracy with error grid analysis and defined mismatch zones as low, medium, or high risk-based on deviance from unity and risk of therapeutic error. We calculated pairwise agreement to a binary decision to transfuse based on a hemoglobin value. Our cohort includes 49,004 ICU admissions from 29,926 patients, resulting in 85,757 CBC-BG hemoglobin pairs. BG hemoglobin was significantly higher (mean bias, 0.43-0.58 g/dL) than CBC hemoglobin with similar Pearson correlation ( R2 ) (0.90-0.91). POC hemoglobin was also significantly higher, but of lower magnitude (mean bias, 0.14 g/dL). Error grid analysis revealed only 78 (< 0.1%) CBC-BG hemoglobin pairs in the high-risk zone. For CBC-BG hemoglobin pairs, at a BG hemoglobin cutoff of greater than 8.0 g/dL, the "number needed to miss" a CBC hemoglobin less than 7 g/dL was 275 and 474 at each institution, respectively.
In this pragmatic two-institution cohort of greater than 29,000 patients, we show similar clinical and analytic accuracy of CBC and BG hemoglobin. Although BG hemoglobin values are higher than CBC hemoglobin values, the small magnitude is unlikely to be clinically significant. Application of these findings may reduce duplicative testing and decrease anemia among critically ill children.
频繁的诊断性采血会导致危重症患儿发生贫血。减少重复的血红蛋白检测，同时保持临床准确性，可以提高患者的治疗效果。本研究的目的是确定不同方法同时获得的血红蛋白测量的分析和临床准确性。
回顾性队列研究。
美国的两家儿童医院。
入住 PICU 的儿童（<18 岁）。
无。
我们从全血细胞计数（CBC）与血气（BG）组合以及即时检测（POC）设备中确定了血红蛋白结果。我们通过比较血红蛋白分布、相关系数和 Bland-Altman 偏差来评估分析准确性。我们通过误差网格分析测量临床准确性，并根据与单位的偏差和治疗错误的风险，将不匹配区域定义为低、中或高风险。我们根据血红蛋白值的差异计算了输血的二元决策的两两一致性。我们的队列包括来自 29926 名患者的 49004 例 ICU 入院，共产生 85757 例 CBC-BG 血红蛋白对。BG 血红蛋白（平均偏差为 0.43-0.58g/dL）显著高于 CBC 血红蛋白（Pearson 相关系数为 0.90-0.91）。POC 血红蛋白也明显偏高，但幅度较小（平均偏差为 0.14g/dL）。误差网格分析显示，只有 78（<0.1%）例 CBC-BG 血红蛋白对处于高风险区。对于 CBC-BG 血红蛋白对，在 BG 血红蛋白截断值大于 8.0g/dL 的情况下，在每个机构中，错过 CBC 血红蛋白<7g/dL 的“需要漏诊的数量”分别为 275 和 474。
在这项由 29000 多名患者组成的实用的两家机构队列研究中，我们发现 CBC 和 BG 血红蛋白具有相似的临床和分析准确性。虽然 BG 血红蛋白值高于 CBC 血红蛋白值，但幅度较小，不太可能具有临床意义。这些发现的应用可能会减少重复检测，并降低危重症患儿的贫血发生率。
