Electronic health record surveillance algorithms facilitate the detection of transfusion-related pulmonary complications.
Background: Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are leading causes of transfusion-related mortality. Notably, poor syndrome recognition and underreporting likely result in an underestimate of their true attributable burden. We aimed to...
| Publicado en: | Transfusion Vol. 53; no. 6; pp. 1205 - 1217 |
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| Autores principales: | , , , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Wiley-Blackwell
Jun2013
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104178262&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 104178262 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00411132 1YB jtl: Transfusion issn: 00411132 maglogo: Y pubinfo: dt: Jun2013 vid: 53 iid: 6 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 104178262 NLM22934792 2012151795 10.1111/j.1537-2995.2012.03886.x NLM22934792 PMC4839484 104178262 ppf: 1205 ppct: 12 formats: tig: atl: Electronic health record surveillance algorithms facilitate the detection of transfusion-related pulmonary complications. aug: au: Clifford, Leanne Singh, Amandeep Wilson, Gregory A Toy, Pearl Gajic, Ognjen Malinchoc, Michael Herasevich, Vitaly Pathak, Jyotishman Kor, Daryl J affil: From the Mayo Clinic, Rochester, Minnesota; and the University of California at San Francisco, San Francisco, California. sug: subj: Acute Lung Injury Epidemiology Algorithms Blood Group Incompatibility Epidemiology Electronic Health Records Population Surveillance Methods Pulmonary Edema Epidemiology Acute Lung Injury Etiology Aged Anoxia Epidemiology Anoxia Etiology Blood Gas Analysis Blood Group Incompatibility Complications Female Human Prospective Studies Male Middle Age Multivariate Analysis Pulmonary Edema Etiology Respiratory Rate Retrospective Design Risk Factors Sensitivity and Specificity Aged: 65+ years Middle Aged: 45-64 years Female Male ab: Background: Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are leading causes of transfusion-related mortality. Notably, poor syndrome recognition and underreporting likely result in an underestimate of their true attributable burden. We aimed to develop accurate electronic health record-based screening algorithms for improved detection of TRALI/transfused acute lung injury (ALI) and TACO.Study Design and Methods: This was a retrospective observational study. The study cohort, identified from a previous National Institutes of Health-sponsored prospective investigation, included 223 transfused patients with TRALI, transfused ALI, TACO, or complication-free controls. Optimal case detection algorithms were identified using classification and regression tree (CART) analyses. Algorithm performance was evaluated with sensitivities, specificities, likelihood ratios, and overall misclassification rates.Results: For TRALI/transfused ALI detection, CART analysis achieved a sensitivity and specificity of 83.9% (95% confidence interval [CI], 74.4%-90.4%) and 89.7% (95% CI, 80.3%-95.2%), respectively. For TACO, the sensitivity and specificity were 86.5% (95% CI, 73.6%-94.0%) and 92.3% (95% CI, 83.4%-96.8%), respectively. Reduced PaO2 /FiO2 ratios and the acquisition of posttransfusion chest radiographs were the primary determinants of case versus control status for both syndromes. Of true-positive cases identified using the screening algorithms (TRALI/transfused ALI, n = 78; TACO, n = 45), only 11 (14.1%) and five (11.1%) were reported to the blood bank by physicians, respectively.Conclusions: Electronic screening algorithms have shown good sensitivity and specificity for identifying patients with TRALI/transfused ALI and TACO at our institution. This supports the notion that active electronic surveillance may improve case identification, thereby providing a more accurate understanding of TRALI/transfused ALI and TACO epidemiology. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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