Development and validation of Transfusion Risk Understanding Scoring Tool (TRUST) to stratify cardiac surgery...

Area of Science:

• Cardiovascular Surgery
• Transfusion Medicine
• Clinical Prediction Modeling

Background:

• Allogeneic blood transfusion carries risks including reactions, infection transmission, and increased postoperative morbidity and mortality.
• Accurate prediction of transfusion requirements is crucial for patient safety in cardiac surgery.
• Current methods for assessing transfusion risk in cardiac surgery patients require improvement.

Purpose of the Study:

• To develop and validate a simple, accurate clinical index for stratifying cardiac surgery patients based on their likelihood of requiring blood transfusion.
• To identify key preoperative variables predictive of allogeneic blood transfusion needs.

Main Methods:

• Data from 16,429 adult cardiac surgery patients (Toronto General Hospital and Sunnybrook Health Sciences Center) were used for index development and validation.
• Multivariable logistic regression identified eight preoperative variables: hemoglobin, weight, sex, age, procedure type, creatinine, prior surgery, and procedure isolation.
• The index was validated internally and externally, comparing predicted probabilities to observed transfusion rates.

Main Results:

• The developed clinical index incorporates eight preoperative variables to predict blood transfusion requirements.
• The index demonstrated accuracy in stratifying patients according to their need for allogeneic blood transfusion.
• Internal and external validation confirmed the tool's reliability across different patient cohorts.

Conclusions:

• A validated clinical tool effectively predicts the need for blood transfusion in cardiac surgery patients.
• The developed index is accurate, simple, and suitable for clinical use.
• The tool's performance suggests it can be successfully implemented at other healthcare institutions.