Evaluation of pediatric transfusion practice using criteria maps

Pediatric blood transfusion practice in a tertiary-care pediatric hospital was evaluated retrospectively by using the technique of criteria mapping. A total of 630 transfusion episodes involving red cell concentrates, frozen plasma (plasma frozen within 24 hours of collection), platelet concentrates, and albumin were reviewed: 243 (86.2%) were reviewed only by a technical assistant, and 87 (13.8%) required additional physician review. Of these, 138 were red cell concentrate transfusions: 79.7 percent of that group were considered appropriate, 11.6 percent of unknown benefit/risk ratio, 5.8 percent inappropriate, and 2.9 percent impossible to evaluate. Some 246 frozen plasma transfusions were reviewed: 42.3 percent were considered appropriate, 32.5 percent of unknown benefit/risk ratio, 17.5 percent inappropriate, and 7.7 percent impossible to evaluate. A total of 139 platelet concentrate transfusions were reviewed: 64.7 percent were considered appropriate, 16.5 percent of unknown benefit/risk ratio, 10.1 percent inappropriate, and 8.6 percent impossible to evaluate. Some 107 albumin transfusions were reviewed: 90.6 percent were considered appropriate, 1.9 percent inappropriate, and 7.5 percent impossible to evaluate. The criteria maps developed for this study were easy for the technical assistant to use, and areas of appropriate and inappropriate pediatric transfusion practice were clearly identified.