The EASTR study: a new approach to determine the reasons for transfusion in epidemiological studies

Abstract

Previous studies of blood use have used different methods to obtain and classify transfusion indications. Before undertaking a national study of transfusion recipients, a pilot study was performed over 2 months at two teaching and two district general hospitals to match information from hospital transfusion laboratories with clinical coding data from the hospital's Patients Administration System to determine the indication for transfusion in 2468 recipients. Data analysis revealed major limitations in the conventional use of primary diagnostic International Statistical Classification of Disease and Related Health Problems 10th Revision (ICD-10) or procedure Office of Population, Censuses and Surveys - Classification of Surgical Operations and Procedures - 4th Revision (OPCS-4) codes alone in allocating transfusion indications. A novel algorithm was developed, using both types of code, to select the probable indication for transfusion for each patient. A primary OPCS-4 code was selected for recipients transfused in relation to surgery (43%) and either the primary (36%) or the secondary (12%) ICD-10 code was chosen for recipients transfused for medical reasons. The remaining patients were unclassified. Selected codes were then collated into Epidemiology and Survival of Transfusion Recipients (EASTR) casemix groups (E-CMGs). The most frequent E-CMGs were haematology (15% of recipients), musculoskeletal (14%), digestive system (12%) and cardiac (10%). The haematology E-CMG includes patients with malignant and non-malignant blood disorders and recipients transfused for anaemia where no cause was listed. Recipients undergoing hip and knee replacement and coronary artery bypass grafting are within the musculoskeletal and cardiac E-CMGs. The digestive E-CMG includes recipients transfused for gastrointestinal (GI) bleeds and those undergoing GI surgery. This methodology provides a more useful means of establishing the probable indication for transfusion and arranging recipients into clinically relevant groups.

Underreporting of major obstetric haemorrhage in the Netherlands

“…This is, however, not the case for the demographic and medical data of the recipient. By linking the databases of the administration of blood products with that of the hospital patient administration system one may obtain information about (broad) patient categories that received defined blood products (Titlestad et al , 2001; Wells et al , 2002; Llewelyn et al , 2009). For this specific question we thought that it might be possible to identify all pregnant women who received blood transfusions.…”

Transfusion-transmitted hepatitis B virus infection

“…These data suggest an increased susceptibility to HBV infection of transplant patients undergoing intensive immunosuppressive therapy in the absence of prophylactic treatment. This situation can be probably derived from organs to blood components as approximately 50% of recipients of blood components in Western Europe present some degree of immunodeficiency [117]. It was shown that both active and passive neutralizing anti-HBs likely delayed but did not prevent acute infection when the immune system was impaired [98].…”

Evaluation of clinical coding data to determine causes of critical bleeding in patients receiving massive transfusion: a bi‐national, multicentre, cross‐sectional study

“…Good to excellent coding quality has been demonstrated for the principal procedure and principal diagnosis code (Campbell et al ; Quan et al , ; Henderson et al , ). However, as expected, these individual codes alone do not always reflect the indication for transfusion (Llewelyn et al , ). For example, studies examining indication for RBC transfusion using DRG data identified that patients with high transfusion requirements are often assigned the tracheostomy DRG (Whyte & Brook, ; Syrjälä et al , ).…”

“…For example, studies examining indication for RBC transfusion using DRG data identified that patients with high transfusion requirements are often assigned the tracheostomy DRG (Whyte & Brook, ; Syrjälä et al , ). Recent studies using algorithms with combinations of diagnosis codes and the principal procedure code to determine reasons for transfusion are promising (Llewelyn et al , ; Wells et al , ). However, their ability to identify causes of critical bleeding in patients who receive MT is unknown, and previous transfusion validation studies have not been performed in ANZ.…”