Randomized Controlled Study on Safety and Feasibility of Transfusion Trigger Score of Emergency Operations

Background： Due to the floating of the guideline, there is no evidence-based evaluation index on when to start the blood transfusion for patients with hemoglobin （Hb） level between 7 and 10 g/dl. As a restdt, the trigger point of blood transtiision may be different in the emergency use of the existing transfusion guidelines. The present study was designed to evaluate whether the scheme can be safely and effectively used for emergency patients, so as to be supported by multicenter and large sample data in the future. Methods： From June 2013 to June 2014, patients were randomly divided into the experimental group （Peri-operative Transfusion Trigger Score of Emergency [POTTS-E] group） and the control group （control group）. The between-group differences in the patients＇ demography and baseline inlbrmation, mortality and blood transfusion-related complications, heart rate, resting arterial pressure, body temperature, and Hb values were compared. The consistency of red blood cell （RBC） transiiision standards of the two groups of patients with the current blood transfusion guideline, namely the compliance of the guidelines, utilization rate, and per-capita consumption of autologous RBC were analyzed. Results： During the study period, a total of 72 patients were recorded, and 65 of them met the inclusion criteria, which included 33 males and 32 females with a mean age of（34.8 ± 14.6） years. 50 tmderwent abdomen surgery, 4 underwent chest surgery, 11 underwent arms and legs surgery. There was no statistical difference between the two groups for demography and baseline inlbrmation. There was also no statistical differences between the two groups in anesthesia time, intraoperative rehydration, staying time in postanesthetic care unit, emergency hospitalization, postoperative 72 h Acute Physiologic Assessment and Chronic Health Evaluation II scores, blood transliision-related complications and mortality. Only tile POTTS-E group on the 1st postoperative day Hb was lower than group control, P 〈 0.05. POTTS-E group was totally （100%） conlbrmed to the requirements of the transfusion guideline to RBC inliision, which was higher than that of the control group （81.25%）, P 〈 0.01.There were no statistical differences in utilization rates of autologous blood of the two groups; the utilization rates ofallogeneic RBC, total allogeneic RBC and total RBC were 48.48%, 51.5%, and 75.7% in POTTS-E group, which were lower than those of the control group （84.3%, 84.3%, and 96.8%） P 〈 0.05 or P 〈 0.01. Per capita consumption of intraoperative allogeneic RBC. total allogeneic RBC and total RBC were 0 （0, 3.0）, 2.0 （0, 4.0）, and 3.1 （0.81, 6.0） in POTTS-E groups were all lower than those of control group （4.0 [2.0, 4.0], 4.0 [2.0, 6.0] and 5.8 [2.7, 8.2]）, P 〈 0.05 or P 〈 0.00 I. Conclusions： Peri-operative Transfilsion Trigger Score-E evaluation scheme is used to guide the application of RBC. There are no differences in the recent prognosis of patients with the traditional transfusion guidelines. This scheme is sate; Compared with doctor experience-based sub iective assessment, the scoring scheme was closer to patient physiological needs lbr transfusion and more reasonable： Utilization rate and the per capita consumption of RBC are obviously declined, which has clinical significance and is feasible. Based on the abovementioned three points, POTTS-E scores scheme is safe, reasonable, and practicable and has the value tbr carrying out multicenter and large sample clinical researches.