Evidence map›Paper›PMID 31208843›Full record

ArticleThe American journal of emergency medicine2020

Red blood cell transfusions for emergency department patients with gastrointestinal bleeding within an integrated health system.

Dustin G Mark, Jie Huang, Colleen Plimier, Mary E Reed, Gabriel J Escobar, David R Vinson, Nareg H Roubinian

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The American journal of emergency medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.1field-weighted citation impact, top 66% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 4 citations in OpenAlex.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 1 country.

Dustin G MarkDepartment of Emergency Medicine, Kaiser Permanente Medical Center, 3600 Broadway, Oakland, CA 94611, USA; Department of Critical Care, Kaiser Permanente Medical Center, 3600 Broadway, Oakland, CA 94611, USA; Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA. Electronic address: Dustin.G.Mark@kp.org.
Jie HuangDivision of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
Colleen PlimierDivision of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
Mary E ReedDivision of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
Gabriel J EscobarDivision of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
David R VinsonDivision of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA; Department of Emergency Medicine, Kaiser Permanente Medical Center, 1600 Eureka Road, 95661 Roseville, CA, USA.
Nareg H RoubinianDepartment of Critical Care, Kaiser Permanente Medical Center, 3600 Broadway, Oakland, CA 94611, USA; Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA; Division of Pulmonology, Kaiser Permanente Medical Center, 3600 Broadway, Oakland, CA 94611, USA.
Kaiser Permanente · USKaiser Permanente Oakland Medical Center · USKaiser Permanente Roseville Medical Center · US

Funding

Effects of blood conservation and donor characteristics on transfused patient outcomes in a large community hospital networkR01HL126130 · NHLBI · VITALANT · PI ROUBINIAN, NAREG · 2016 to 2019
$1.9M
NHLBI NIH HHS R01 HL126130
6 · The paper itself

Abstract

STUDY

objectiveTo assess trends over time in red blood cell (RBC) transfusion practice among emergency department (ED) patients with gastrointestinal (GI) bleeding within an integrated healthcare system, inclusive of 21 EDs.

methodsRetrospective cohort of ED patients diagnosed with GI bleeding between July 1st, 2012 and September 30th, 2016. The primary outcome was receipt of an RBC transfusion in the ED. Secondary outcomes included 90-day rates of RBC transfusion, repeat ED visits, rehospitalization, and all-cause mortality. Logistic regression was used to obtain confounder-adjusted outcome rates.

resultsA total of 24,868 unique patient encounters were used for the primary analysis. The median hemoglobin level in the ED prior to RBC transfusion decreased from 7.5 g/dl to 6.9 g/dl in the first versus last twelve months of the study period (p < 0.0001). A small trend was observed in the overall adjusted rate of ED RBC transfusion (absolute quarterly change of -0.1%, R2 = 0.18, p = 0.0001) largely attributable to the subgroup of patients with hemoglobin nadirs between 7.0 and 9.9 g/dl (absolute quarterly change of -0.4%, R2 = 0.38, p < 0.0001). Rates of RBC transfusions through 90 days likewise decreased (absolute quarterly change of -0.4%, R2 = 0.85, p < 0.0001) with stable to decreased corresponding rates of repeat ED visits, rehospitalizations and mortality.

conclusionRates of ED RBC transfusion decreased over time among patients with GI bleeding, particularly in those with hemoglobin nadirs between 7.0 and 9.9 g/dl. These findings suggest that ED providers are willing to adopt evidence-based restrictive RBC transfusion recommendations for patients with GI bleeding.

Indexed as

AdultCaliforniaCohort StudiesDelivery of Health Care, IntegratedEmergency Service, HospitalErythrocyte TransfusionFemaleGastrointestinal HemorrhageHumansLogistic ModelsMaleMiddle AgedRetrospective StudiesEmergency departmentGastrointestinal bleedingGuideline adherenceRed blood cellTransfusion

Identifiers

PMID31208843
PMCPMC6901807
OpenAlexW2951551493

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.