Clinical coding data algorithm to categorize type of gastrointestinal bleeding as a primary reason for massive transfusion: results from the Australian and New Zealand Massive Transfusion Registry

Ket, Shara; McQuilten, Zoe; Tacey, Mark; Wood, Erica M.

doi:10.1111/vox.12840

Cited by 3 publications

(3 citation statements)

References 21 publications

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“…In the study by Ket SN and al. transfusion was needed in 85% of patients with mainfested upper gastrointestinal bleeding (19). Rebleeding during hospitalization was observed in 7% of patients, surgical intervention in 3% and mortality in 3% of patients.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Patients with Nonvariceal Upper Gastrointestinal Bleeding - Are We Underestimating Gastroprotection during NSAIDs Therapy?

Čustović

Saray

Ćato-Mehmedbašić

et al. 2021

ama

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Objective. The aim of our study was to determine the etiological factors, treatment and outcome of patients with non-variceal bleeding from upper gastrointestinal tract.Materials and Methods. This study enrolled 200 patients admitted to Sarajevo University Clinical Center with signs and symptoms of upper gastrointestinal bleeding, from January 2019 to July 2020. All patients had undergone gastroscopy, confirming the cause of gastrointestinal bleeding. Clinical and laboratory data were collected retrospectively, including previous non-steroid antiinflammatory drugs (NSAIDs) and anticoagulant therapy, comorbidities, risk factors, as well as endoscopic findings, laboratory findings, treatment and clinical follow-up.Results. The majority of patients were men (59%) with an average age of 53±6 years. Duodenal and gastric ulcers were the most common cause, followed by other etiologies. In our study, previous NSAIDs therapy had been registered in 29.5% of patients, anticoagulants in 8%, and proton pump inhibitors (PPI) in 2.9% of patients. Endoscopic intervention was required in 34% of patients. The need for transfusion occurred in 44.5% of cases. Rebleeding during hospitalization was observed in 7.5% of patients, mortality in 1.5% and surgery in 3% of patients.Conclusion. The patients admitted to our hospital with symptoms of acute nonvariceal upper gastrointestinal bleeding were elderly, predominantly males, with significant comorbidities and a higher incidence of NSAID use. Gastroprotection is underutilized during NSAID treatment in patients with other coexisting risk factors,with a low rate of concomitant use of PPI during NSAIDs therapy. Endoscopic therapy, together with PPI, significantly reduces rebleeding rates, mortality and the number of emergency surgical interventions.

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Section: Discussionmentioning

confidence: 99%

Characteristics of Patients with Nonvariceal Upper Gastrointestinal Bleeding - Are We Underestimating Gastroprotection during NSAIDs Therapy?

Čustović

Saray

Ćato-Mehmedbašić

et al. 2021

ama

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“…Gastrointestinal bleeding accounts for about 14% of cases of major bleeding requiring MT (25,26). Although most cases of UGIB are minor and not associated with hemodynamic instability, transfusions are considered life-saving in the event of massive exsanguinating hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Prospective validation of the BISHE score as a predictor of the need for massive transfusion in patients with upper gastrointestinal bleeding

Chen¹,

Hung²

2020

Preprint

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Background: Emergency transfusion strategies for patients with upper gastrointestinal bleeding (UGIB) have not been well developed. The BISHE is a recently developed scoring system for prediction of patients likely to require massive transfusion but has not been validated. In this study, we evaluated the predictive ability of the BISHE score and that of a revised scoring system in an effort to improve care for patients with UGIB and allow better resource allocation. Methods: This prospective observational cohort study included patients who were admitted to our hospital between July 1, 2016 and June 30, 2019 and required massive transfusion (defined as receiving three units of red blood cells over one hour) in the emergency department. The predictive accuracy of the BISHE score and that of the revised scoring system were compared using area under the receiver-operating characteristic (AUROC) curve analysis. Results: Liver cirrhosis, an international normalized ratio >1.5, and hemoglobin <8.0 g/dL were independently associated (p<0.05) with requirement for massive transfusion. The revised scoring system discriminated successfully between patients with UGIB requiring massive transfusion and their counterparts who did not (AUROC 0.82, 95% confidence interval 0.78–0.86) and performed better than the BISHE score (AUROC 0.73, 95% confidence interval 0.69–0.76; p=0.004).Conclusions: Compared with the BISHE score, the revised scoring system was better able to identify patients likely to require massive transfusion.

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“…The methodology for identification of upper gastrointestinal bleeding cases receiving massive transfusion captured in the ANZ-MTR has previously been described. 12 Peptic ulcer bleeding was identified from discharge diagnosis codes (K25* gastric ulcer, K26* duodenal ulcer and K27* peptic ulcer) according to the International Classification of Diseases, 10th Revision, Australian Modification (ICD-10-AM). 13 Cases coded with non-bleeding peptic ulcers, bleeding or nonbleeding oesophageal or gastric varices and cases with other concurrent indications for massive blood transfusion (e.g.…”

Section: Study Cohortmentioning

confidence: 99%

Critical peptic ulcer bleeding requiring massive blood transfusion: outcomes of 270 cases

Ket

McQuilten

Wood

2021

Internal Medicine Journal

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Background: Critical peptic ulcer bleeding requiring massive transfusion is a gastroenterological emergency. Few data exist on management and outcomes. The Australian and New Zealand Massive Transfusion Registry collects comprehensive data on adult patients receiving massive transfusion across all bleeding contexts. Aim: To evaluate clinical factors, management (procedural interventions, transfusions) and outcomes after massive transfusion for critical peptic ulcer bleeding. Method: Demographics, diagnosis, procedures and mortality data were available for 5482 massive transfusion cases from 23 hospitals. International Classification of Diseases 10th Edition, Australian Modification codes were used to determine peptic ulcer bleeding and the Australian Classification of Health Intervention for interventions (i.e. endoscopic, radiological, surgical).Results: Peptic ulcer bleeding accounted for 270 (4.9%) of all in-hospital massive transfusion cases; 70% were male. Median number of red blood cell (RBC) units transfused was 7 (interquartile range, 6-10). Thirty-day mortality was 19.6%. Age (75 vs 67 years; P = 0.009) and Charlson Comorbidity Index (3 vs 1; P < 0.001) were higher in those who died. Highest 24-h international normalised ratio (1.5 vs 1.4; P < 0.001) and creatinine (118 μmol/L vs 96 μmol/L; P = 0.03) and nadir platelet count (86 × 10 9 /L vs 118 × 10 9 /L; P = 0.01) were also associated with 30-day mortality. There were no differences in mortality according to number of RBC, platelets or plasma units transfused, gastroscopy (with or without intervention), interventional radiology or surgery. Conclusion:One in five patients with critical peptic ulcer bleeding requiring massive transfusion died by 30 days. Mortality was associated with patient characteristics rather than clinical interventions (e.g. procedures, blood product transfusion).

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Clinical coding data algorithm to categorize type of gastrointestinal bleeding as a primary reason for massive transfusion: results from the Australian and New Zealand Massive Transfusion Registry

Cited by 3 publications

References 21 publications

Characteristics of Patients with Nonvariceal Upper Gastrointestinal Bleeding - Are We Underestimating Gastroprotection during NSAIDs Therapy?

Characteristics of Patients with Nonvariceal Upper Gastrointestinal Bleeding - Are We Underestimating Gastroprotection during NSAIDs Therapy?

Prospective validation of the BISHE score as a predictor of the need for massive transfusion in patients with upper gastrointestinal bleeding

Critical peptic ulcer bleeding requiring massive blood transfusion: outcomes of 270 cases

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