Predicting the need for blood transfusion in patients with hip fractures

Abstract

Purpose: The need for perioperative blood management measures aimed at improving patient outcomes and reducing allogenic blood transfusion (ABT) is increasingly recognised. Our study aim is to create an algorithm to predict and manage the need for blood transfusion in patients with hip fractures.

Methods: We retrospectively assessed 1,484 patients with hip fractures and analysed the probability of receiving an ABT within 72 hours of admission. Univariate, multiple logistic regression analysis and a probability algorithm for predicting the need for blood transfusion on the basis of independent multivariate predictors were used.

Results: Significant predictors for ABT were: older age; lower haemoglobin on admission; female gender; type of surgical implant (cephalomedullary nail and dynamic hip screw more than hemiarthroplasty); and a shorter wait time from admission to surgery. A regression model algorithm correctly predicted the need for an ABT in 73 % of the cases.

Conclusion: An algorithm and a simple clinical tool were devised to predict and manage the need for a blood transfusion within 72 hours of admission in patients with hip fractures.

Figures

Fig. 1

A receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive performance of logistic regression model to predict allogenic blood transfusion (ABT) transfusion within 72 hours. The area under the curve (79 %) demonstrated good diagnostic performance

Fig. 2

GASH score—A clinical tool based on four variables of patients with hip fractures: Gender, Age, Type of Surgery and Haemoglobin. The tool was devised to predict the future need of a patient for an allogenic blood transfusion (ABT) within 72 hours

Fig. 3

A predictive formula based on the five significant risk factors model used to predict the need for an allogenic blood transfusion (ABT) within 72 hours of admission in patients with hip fracture

Fig. 4

Kaplan-Meier survival curve for patients with hip fractures, divided to four groups according to Haemoglobin levels. A significant difference (P = 0.000) exists between the groups. Hb haemoglobin (g/dl) * Compared with LogRank test