医疗机构在接受输血治疗的创伤患者中采用平衡输血实践方面的差异。
Hospital variation in adoption of balanced transfusion practices among injured patients requiring blood transfusions.
机构信息
Department of surgery, Albany Medical College, New York, NY.
Feinberg School of Medicine, Northwestern University, Chicago, IL.
出版信息
Surgery. 2024 Oct;176(4):1273-1280. doi: 10.1016/j.surg.2024.06.037. Epub 2024 Jul 27.
BACKGROUND
This study sought to measure hospital variability in adoption of balanced transfusion following the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) guidelines. We hypothesized hospital adoption rates of balanced transfusion would be low, and vary significantly among hospitals after controlling for patient, injury and hospital characteristics.
STUDY DESIGN AND METHODS
This was an observational cohort study of injured adult patients (≥16 years) in Trauma Quality Improvement Program hospitals 2016-2021. Inclusion criteria were hypotensive patients receiving one transfusion of packed red blood cells, fresh frozen plasma, platelets, or cryoprecipitate. Balanced transfusion was defined as ≥1 ratio of plasma to packed red blood cells or platelets to packed red blood cells or whole blood use at 4 hours. Hierarchical multivariable logistic regression quantified residual hospital-level variability in balanced transfusion rates after adjusting for patient and hospital characteristics.
RESULTS
Among 172,457 injured patients who received transfusions, 30,386 (17.6%) underwent balanced transfusion. Patient-level balanced transfusion rates were 11% in 2016, rose to 14.0% in 2019, and jumped up once whole blood transfusions were measured to 24.0% in 2020 and to 25.9% in 2021. Approximately 26% of the variability in balanced transfusion rates was attributable to the hospital. Verified level I hospitals had a 2.09 increased adjusted odds of balanced transfusion (95% CI 1.88-2.21) compared to nonverified hospitals. University teaching status had a 1.29 increased adjusted odds of balanced transfusion (95% CI 1.08-1.54) compared with community hospitals. Overall, 150 (23.5%) hospitals were high outliers (high performing) in balanced transfusion adoption and 124 (19.4%) hospitals were low outliers.
CONCLUSION
There was significant variability in hospital adoption of balanced transfusion.
背景
本研究旨在衡量 Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) 指南发布后，各医院在采用平衡输血方面的差异。我们假设，在控制患者、损伤和医院特征后，平衡输血的采用率将较低，且各医院之间差异显著。
研究设计与方法
这是一项观察性队列研究，纳入 2016 年至 2021 年期间创伤质量改进计划医院中接受输血的成年受伤患者（≥16 岁）。纳入标准为接受 1 次以下输血的低血压患者：浓缩红细胞、新鲜冰冻血浆、血小板或冷沉淀。平衡输血定义为 4 小时内血浆与浓缩红细胞的比例≥1，或血小板与浓缩红细胞的比例≥1，或全血的使用。分层多变量逻辑回归量化了调整患者和医院特征后，平衡输血率的剩余医院水平差异。
结果
在 172457 名接受输血的受伤患者中，30386 名（17.6%）进行了平衡输血。患者层面的平衡输血率在 2016 年为 11%，2019 年上升至 14.0%，2020 年全血输血开始测量后跃升至 24.0%，2021 年进一步上升至 25.9%。平衡输血率的约 26%差异归因于医院。与未验证的医院相比，验证一级医院的平衡输血校正后优势比（95%CI 1.88-2.21）增加了 2.09 倍。与社区医院相比，大学教学状态的平衡输血校正后优势比（95%CI 1.08-1.54）增加了 1.29 倍。总体而言，150 家（23.5%）医院在平衡输血的采用方面是高异常值（表现良好），124 家（19.4%）医院是低异常值。
结论
各医院在平衡输血的采用方面存在显著差异。
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