在手术中预测输血的风险评估工具:系统审查和元分析
Abril Seyahian1, Martin Taylor-Rowan1, Clareece Nevill2
1Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Health technology assessment (Winchester, England)
|December 6, 2025
概括
目前用于输血的外科预测工具不适合临床使用,因为偏差风险高,验证有限. 需要进一步的研究来提高准确性和评估更好的血液管理的成本效益.
科学领域:
- 医学研究 医学研究
- 外科手术的结果
- 卫生技术评估 卫生技术评估
背景情况:
- 英国面临着血液短缺问题,这凸显了需要更好地预测手术血液需求的必要性.
- 评估现有工具的准确性,以识别需要术后输血的患者至关重要.
研究的目的:
- 评估旨在识别在外科手术期间需要输血的患者的工具的预测准确性.
- 综合关于手术血液需求预测工具性能的证据.
主要方法:
- 在多个数据库 (Cochrane,EMBASE,MEDLINE等) 中进行了系统的文献搜索. 从2000年开始到2023年7月.
- 包括的研究开发或验证了预测工具,用于早期外科手术后血液需求 (48小时).
- 偏差,歧视 (AUC) 和校准风险使用既有框架 (PROBAST,GRADE) 和元分析/元回归来评估.
主要成果:
- 50篇论文描述了67种预测工具,大多数具有高偏差风险和有限的外部验证.
- 歧视 (AUC) 范围在0.49到0.96;只有两个手术特定工具 (麦克拉斯基指数,帕普沃思出血风险评分) 汇总了数据,两者都具有"非常低"的确定性.
- 超回归表明变量较少,手术后的时间较长,独立验证与较低的准确性有关.
结论:
- 目前没有可用的预测工具适合预测手术实践中的输血需求.
- 关于证据质量和大多数工具的外部验证存在重大限制.
- 对于有前途的工具,需要进一步的实施和成本效益研究.
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