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The Pediatric Critical Care Transfusion and Anemia Expertise Initiative Consensus Conference Methodology
Melania M Bembea1, Stacey L Valentine2, Scot T Bateman2
1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Insights
International experts developed evidence-based guidelines for red blood cell (RBC) transfusions in critically ill children. This initiative identified research gaps and future priorities for pediatric critical care anemia management.
Area of Science:
- Pediatric Critical Care Medicine
- Transfusion Medicine
- Hematology
Background:
- Pediatric critical care often involves red blood cell (RBC) transfusions.
- Evidence-based guidelines are needed for optimal transfusion practices in critically ill children.
- Existing guidelines may not adequately address the unique needs of this patient population.
Purpose of the Study:
- To establish consensus-based clinical recommendations for RBC transfusions in critically ill children.
- To identify research gaps and prioritize future research in pediatric transfusion medicine.
- To develop a comprehensive framework for managing anemia in pediatric critical care.
Main Methods:
- A consensus conference involving 38 content and 4 methodology experts.
- Systematic literature review across PubMed, Embase, and Cochrane Library (1980-2017).
- The Research and Development/UCLA Appropriateness Method was used for consensus building.
Main Results:
- 102 recommendation statements were generated: 57 clinical and 45 research priorities.
- Clinical recommendations included 20 evidence-based and 37 expert-consensus statements.
- Recommendations covered various aspects of RBC transfusion in critically ill children.
Conclusions:
- The consensus conference successfully developed recommendations for RBC transfusions in critically ill children.
- Key research gaps and future priorities were identified to advance pediatric transfusion medicine.
- The findings provide a foundation for evidence-based anemia management in pediatric critical care.
Objectives:
This article describes the methodology used for Pediatric Critical Care Transfusion and Anemia Expertise Initiative Consensus Conference.
Design:
Consensus conference of international experts in pediatric critical care and transfusion medicine, following standards set by the Institute of Medicine, using the Research and Development/UCLA Appropriateness Method, modeled after the Pediatric Acute Lung Injury Consensus Conference. Topics related to RBC transfusion in children with or at risk for critical illness were divided into nine subgroups with a systematic review of the literature.
Methods:
The panel of 38 content and four methodology experts met three times over the course of 2 years and collaborated to develop evidence-based and, when evidence was lacking, expert-based clinical recommendations as well as research priorities for RBC transfusions in critically ill children or those at risk for critical illness. Electronic searches were conducted using PubMed, Embase, and Cochrane Library databases from 1980 to May 2017. Agreement was obtained using the Research and Development/UCLA Appropriateness Method. We used a standardized data extraction form to construct evidence tables and graded the evidence using the Grading of Recommendations Assessment, Development, and Evaluation system.
Main Results:
The consensus conference resulted in 102 recommendation statements, of which 57 were clinical (20 evidence based and 37 based on expert consensus) and 45 detailed recommendations for future research. Dissemination was done via decision tree, a primary publication listing all statements, and separate publications for each subtopic that include supporting arguments for each recommendation.
Conclusions:
A consensus conference of experts from around the world developed recommendations for RBC transfusions in critically ill children or children at risk for critical illness, the identification of current research gaps, and future research priorities.
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