Electronic health record surveillance algorithms facilitate the detection of transfusion-related pulmonary complications. Academic Article Article uri icon

Overview

MeSH

  • Aged
  • Blood Gas Analysis
  • Female
  • Humans
  • Hypoxia
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Respiratory Rate
  • Retrospective Studies
  • Risk Factors
  • Sensitivity and Specificity

MeSH Major

  • Acute Lung Injury
  • Algorithms
  • Blood Group Incompatibility
  • Electronic Health Records
  • Population Surveillance
  • Pulmonary Edema

abstract

  • 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. 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. 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. 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. © 2012 American Association of Blood Banks.

publication date

  • June 2013

has subject area

  • Acute Lung Injury
  • Aged
  • Algorithms
  • Blood Gas Analysis
  • Blood Group Incompatibility
  • Electronic Health Records
  • Female
  • Humans
  • Hypoxia
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Population Surveillance
  • Pulmonary Edema
  • Respiratory Rate
  • Retrospective Studies
  • Risk Factors
  • Sensitivity and Specificity

Research

keywords

  • Journal Article
  • Multicenter Study

Identity

Language

  • eng

PubMed Central ID

  • PMC4839484

Digital Object Identifier (DOI)

  • 10.1111/j.1537-2995.2012.03886.x

PubMed ID

  • 22934792

Additional Document Info

start page

  • 1205

end page

  • 1216

volume

  • 53

number

  • 6