A224 BLOOD TRANSFUSION IN UPPER GASTROINTESTINAL BLEEDING: EVALUATING PHYSICIAN PRACTICES IN THE EMERGENCY DEPARTMENT
Bibliographic record
Abstract
Acute upper gastrointestinal bleeding (UGIB) is a common presentation to emergency departments (ED). Of these patients, 35–45% receive a blood transfusion. Guidelines for blood transfusion in stable UGIB have been well established, and recommend a hemoglobin (Hb) level of 70 g/L as the transfusion target. There is no consensus on a transfusion threshold for unstable UGIB. There is limited data regarding physician practices in the ED. i) To determine the appropriateness of blood transfusions in UGIB in a tertiary care hospital ED. ii) To determine if the current guideline recommendation for a transfusion target of a Hb of 70 g/L is appropriate in unstable UGIB. We retrospectively reviewed patients presenting with UGIB to the University of Alberta Hospital ED in 2016. The Emergency Department Information System (EDIS) and TANDEM databases were queried for ICD-10 codes and the EDIS complaints of vomiting blood or blood in stool/melena. These patients were screened for blood transfusions, and only those who received a blood transfusion are reported here. Data were obtained from the patient records. Chart derived data were verified with records obtained from the blood bank. For each patient, the history, vitals, Glasgow Blatchford Score (GBS), relevant labs, and record of blood transfusions were collected and organized into a case summary. Each patient summary was presented individually to a panel of three expert clinicians (2 Gastroenterology, 1 Emergency Medicine), who then decided on the appropriateness of each blood transfusion by consensus. 43.5% (87/200) of patients presenting with UGIB received a blood transfusion. Of these, 80.4% (70/87) were judged to be appropriate. Details of the transfusion data are shown in Table 1. Of all transfusions received by patients with a Hb >70 g/L, 56.4% (22/39) were considered appropriate. 80% of blood transfusions for UGIB at our institution were considered appropriate by a panel of expert clinicians. All transfusions under the recommended guideline of 70 g/L were considered appropriate. In addition, the majority of transfusions above a Hb of 70 g/L were considered appropriate. Further studies evaluating the feasibility of current guideline recommendations in an ED setting are required. Educational interventions should be created to reduce inappropriate blood transfusions above a Hb of 70 g/L. Table 1: Blood transfusions (total number and appropriate) organized by hemoglobin level at time of transfusion. Emergency Strategic Clinical Network (ESCN), Alberta Health Services (AHS)
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".