ArticleO&G open2025
Development of a Risk-Scoring System for Prediction of Blood Transfusion During Hospitalization for Delivery.
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1 citing paper in PubMed.
- Weighted risk scoring system for predicting peripartum transfusion: development and internal validation.Frontiers in medicine · 2026Article
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Authors and funding
15 authors.
Ann M BrunoUniversity of Utah Health Sciences Center, Salt Lake City, Utah; the George Washington University Biostatistics Center, Washington, DC; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Northwestern University, Chicago, Illinois; the University of Texas Medical Branch, Galveston, and the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the University of Pittsburgh, Pittsburgh, and the University of Pennsylvania, Philadelphia, Pennsylvania; Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island; Columbia University, New York, New York; Case Western Reserve University, Cleveland, and The Ohio State University, Columbus, Ohio; and the University of Alabama at Birmingham, Birmingham, Alabama.
Grecio J SandovalUniversity of Utah Health Sciences Center, Salt Lake City, Utah; the George Washington University Biostatistics Center, Washington, DC; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Northwestern University, Chicago, Illinois; the University of Texas Medical Branch, Galveston, and the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the University of Pittsburgh, Pittsburgh, and the University of Pennsylvania, Philadelphia, Pennsylvania; Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island; Columbia University, New York, New York; Case Western Reserve University, Cleveland, and The Ohio State University, Columbus, Ohio; and the University of Alabama at Birmingham, Birmingham, Alabama.
Brenna L HughesUniversity of Utah Health Sciences Center, Salt Lake City, Utah; the George Washington University Biostatistics Center, Washington, DC; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Northwestern University, Chicago, Illinois; the University of Texas Medical Branch, Galveston, and the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the University of Pittsburgh, Pittsburgh, and the University of Pennsylvania, Philadelphia, Pennsylvania; Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island; Columbia University, New York, New York; Case Western Reserve University, Cleveland, and The Ohio State University, Columbus, Ohio; and the University of Alabama at Birmingham, Birmingham, Alabama.
William A GrobmanUniversity of Utah Health Sciences Center, Salt Lake City, Utah; the George Washington University Biostatistics Center, Washington, DC; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Northwestern University, Chicago, Illinois; the University of Texas Medical Branch, Galveston, and the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the University of Pittsburgh, Pittsburgh, and the University of Pennsylvania, Philadelphia, Pennsylvania; Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island; Columbia University, New York, New York; Case Western Reserve University, Cleveland, and The Ohio State University, Columbus, Ohio; and the University of Alabama at Birmingham, Birmingham, Alabama.
George R SaadeUniversity of Utah Health Sciences Center, Salt Lake City, Utah; the George Washington University Biostatistics Center, Washington, DC; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Northwestern University, Chicago, Illinois; the University of Texas Medical Branch, Galveston, and the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the University of Pittsburgh, Pittsburgh, and the University of Pennsylvania, Philadelphia, Pennsylvania; Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island; Columbia University, New York, New York; Case Western Reserve University, Cleveland, and The Ohio State University, Columbus, Ohio; and the University of Alabama at Birmingham, Birmingham, Alabama.
Tracy A ManuckUniversity of Utah Health Sciences Center, Salt Lake City, Utah; the George Washington University Biostatistics Center, Washington, DC; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Northwestern University, Chicago, Illinois; the University of Texas Medical Branch, Galveston, and the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the University of Pittsburgh, Pittsburgh, and the University of Pennsylvania, Philadelphia, Pennsylvania; Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island; Columbia University, New York, New York; Case Western Reserve University, Cleveland, and The Ohio State University, Columbus, Ohio; and the University of Alabama at Birmingham, Birmingham, Alabama.
Monica LongoUniversity of Utah Health Sciences Center, Salt Lake City, Utah; the George Washington University Biostatistics Center, Washington, DC; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Northwestern University, Chicago, Illinois; the University of Texas Medical Branch, Galveston, and the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the University of Pittsburgh, Pittsburgh, and the University of Pennsylvania, Philadelphia, Pennsylvania; Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island; Columbia University, New York, New York; Case Western Reserve University, Cleveland, and The Ohio State University, Columbus, Ohio; and the University of Alabama at Birmingham, Birmingham, Alabama.
Hyagriv N SimhanUniversity of Utah Health Sciences Center, Salt Lake City, Utah; the George Washington University Biostatistics Center, Washington, DC; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Northwestern University, Chicago, Illinois; the University of Texas Medical Branch, Galveston, and the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the University of Pittsburgh, Pittsburgh, and the University of Pennsylvania, Philadelphia, Pennsylvania; Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island; Columbia University, New York, New York; Case Western Reserve University, Cleveland, and The Ohio State University, Columbus, Ohio; and the University of Alabama at Birmingham, Birmingham, Alabama.
Dwight J RouseUniversity of Utah Health Sciences Center, Salt Lake City, Utah; the George Washington University Biostatistics Center, Washington, DC; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Northwestern University, Chicago, Illinois; the University of Texas Medical Branch, Galveston, and the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the University of Pittsburgh, Pittsburgh, and the University of Pennsylvania, Philadelphia, Pennsylvania; Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island; Columbia University, New York, New York; Case Western Reserve University, Cleveland, and The Ohio State University, Columbus, Ohio; and the University of Alabama at Birmingham, Birmingham, Alabama.
Hector Mendez-FigueroaUniversity of Utah Health Sciences Center, Salt Lake City, Utah; the George Washington University Biostatistics Center, Washington, DC; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Northwestern University, Chicago, Illinois; the University of Texas Medical Branch, Galveston, and the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the University of Pittsburgh, Pittsburgh, and the University of Pennsylvania, Philadelphia, Pennsylvania; Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island; Columbia University, New York, New York; Case Western Reserve University, Cleveland, and The Ohio State University, Columbus, Ohio; and the University of Alabama at Birmingham, Birmingham, Alabama.
Cynthia Gyamfi-BannermanUniversity of Utah Health Sciences Center, Salt Lake City, Utah; the George Washington University Biostatistics Center, Washington, DC; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Northwestern University, Chicago, Illinois; the University of Texas Medical Branch, Galveston, and the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the University of Pittsburgh, Pittsburgh, and the University of Pennsylvania, Philadelphia, Pennsylvania; Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island; Columbia University, New York, New York; Case Western Reserve University, Cleveland, and The Ohio State University, Columbus, Ohio; and the University of Alabama at Birmingham, Birmingham, Alabama.
Jennifer L BailitUniversity of Utah Health Sciences Center, Salt Lake City, Utah; the George Washington University Biostatistics Center, Washington, DC; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Northwestern University, Chicago, Illinois; the University of Texas Medical Branch, Galveston, and the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the University of Pittsburgh, Pittsburgh, and the University of Pennsylvania, Philadelphia, Pennsylvania; Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island; Columbia University, New York, New York; Case Western Reserve University, Cleveland, and The Ohio State University, Columbus, Ohio; and the University of Alabama at Birmingham, Birmingham, Alabama.
Maged M CostantineUniversity of Utah Health Sciences Center, Salt Lake City, Utah; the George Washington University Biostatistics Center, Washington, DC; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Northwestern University, Chicago, Illinois; the University of Texas Medical Branch, Galveston, and the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the University of Pittsburgh, Pittsburgh, and the University of Pennsylvania, Philadelphia, Pennsylvania; Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island; Columbia University, New York, New York; Case Western Reserve University, Cleveland, and The Ohio State University, Columbus, Ohio; and the University of Alabama at Birmingham, Birmingham, Alabama.
Harish M SehdevUniversity of Utah Health Sciences Center, Salt Lake City, Utah; the George Washington University Biostatistics Center, Washington, DC; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Northwestern University, Chicago, Illinois; the University of Texas Medical Branch, Galveston, and the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the University of Pittsburgh, Pittsburgh, and the University of Pennsylvania, Philadelphia, Pennsylvania; Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island; Columbia University, New York, New York; Case Western Reserve University, Cleveland, and The Ohio State University, Columbus, Ohio; and the University of Alabama at Birmingham, Birmingham, Alabama.
Alan T N TitaUniversity of Utah Health Sciences Center, Salt Lake City, Utah; the George Washington University Biostatistics Center, Washington, DC; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Northwestern University, Chicago, Illinois; the University of Texas Medical Branch, Galveston, and the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the University of Pittsburgh, Pittsburgh, and the University of Pennsylvania, Philadelphia, Pennsylvania; Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island; Columbia University, New York, New York; Case Western Reserve University, Cleveland, and The Ohio State University, Columbus, Ohio; and the University of Alabama at Birmingham, Birmingham, Alabama.
Funding
Clinical and Translational Science AwardUL1TR001873 · NCATS · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI REILLY, MUREDACH P · 2016 to 2025
$99.0MSARS-CoV-2 Vaccine Pregnancy RegistryU24HD036801 · NICHD · GEORGE WASHINGTON UNIVERSITY · PI Rebecca Gersnoviez Clifton · 2021 to 2026
$39.2MMaternal-Fetal Medicine Units (MFMU) NetworkUG1HD040485 · NICHD · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI Noelia Milena Modad Zork · 2016 to 2026
$3.6MNICHD Maternal Fetal Medicine Units NetworkUG1HD087192 · NICHD · UNIVERSITY OF PENNSYLVANIA · PI Lorraine Dugoff · 2016 to 2026
$3.6MNICHD Maternal-Fetal Medicine Units (MFMU) NetworkUG1HD040544 · NICHD · CASE WESTERN RESERVE UNIVERSITY · PI Kelly S Gibson, Angela C. Ranzini · 2016 to 2026
$3.5MMaternal-Fetal Medicine Units Network -- The Northwestern Study CenterUG1HD040512 · NICHD · NORTHWESTERN UNIVERSITY AT CHICAGO · PI Lynn M Yee · 2016 to 2026
$3.4MNICHD Maternal-Fetal Medicine Units (MFMU) NetworkUG1HD040500 · NICHD · WOMEN AND INFANTS HOSPITAL-RHODE ISLAND · PI DWIGHT J ROUSE · 2016 to 2026
$3.4MUofU Maternal-Fetal Medicine Units (MFMU) Network: Clinical CentersUG1HD034208 · NICHD · UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH · PI Torri D Metz · 2016 to 2026
$3.4MNICHD Maternal Fetal Medicine Units NetworkUG1HD027915 · NICHD · OHIO STATE UNIVERSITY · PI Maged Costantine · 2016 to 2026
$3.3MUNC MFMU: Advancing Perinatal Health via Definitive, Multi-Site Clinical StudiesUG1HD040560 · NICHD · UNIV OF NORTH CAROLINA CHAPEL HILL · PI John M Thorp · 2016 to 2026
$3.3MNICHD Maternal-Fetal Medicine Units (MFMU) NetworkUG1HD087230 · NICHD · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI HYAGRIV N SIMHAN · 2016 to 2026
$3.2MNICHD Maternal-Fetal Medicine Units (MFMU) NetworkUG1HD040545 · NICHD · UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON · PI Hector Mendez-Figueroa · 2016 to 2026
$3.2MNCATS NIH HHS UL1 TR001873NICHD NIH HHS U24 HD036801NICHD NIH HHS UG1 HD027869NICHD NIH HHS UG1 HD027915NICHD NIH HHS UG1 HD034208NICHD NIH HHS UG1 HD040485NICHD NIH HHS UG1 HD040500NICHD NIH HHS UG1 HD040512NICHD NIH HHS UG1 HD040544NICHD NIH HHS UG1 HD040545NICHD NIH HHS UG1 HD040560NICHD NIH HHS UG1 HD053097NICHD NIH HHS UG1 HD087192NICHD NIH HHS UG1 HD087230NICHD NIH HHS UG1 HD112063
Abstract
objectiveTo develop and internally validate a practical and data-driven risk-scoring system to predict blood transfusion during hospitalization for delivery in a contemporary U.S. cohort.
methodsThis was a secondary analysis of a multicenter cohort of patients who delivered on randomly selected days at 17 U.S. hospitals (2019-2020). Patients with placenta accreta spectrum were excluded. The primary outcome was any blood transfusion during hospitalization for delivery. Candidate risk factors for transfusion were selected based on relevant literature. A multivariable logistic regression model was developed and internally validated using stratified k-fold (k=5) cross validation with stepwise backward elimination that used significance level of 0.05. Each risk factor included in the final model was assigned a point value by dividing the log of the odds ratio (OR) by the log of the OR of the factor with the lowest value. The summed points for an individual generate a numeric risk score predictive of transfusion. Performance of the risk score to predict transfusion was assessed using the area under the receiver operating curve (AUC).
resultsOf 21,780 included individuals, 2.5% (n=545) received a blood transfusion. Factors associated with the highest risk for transfusion in the final model included thrombocytopenia, and placental abruption or significant antepartum bleeding. Risk score outputs among patients in the cohort ranged from 0 to 17 (maximum possible 26) with a corresponding predicted risk for transfusion from 1.0% to 84.4%. The AUC for prediction of transfusion in the validation subsample was 0.81 (95% CI, 0.76-0.85).
conclusionWe developed a clinically applicable numeric risk score to predict blood transfusion during hospitalization for delivery. Future work should externally validate this risk-scoring system.
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