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X a Focused Evaluation of Single-Unit Plasma Transfusions in a Tertiary

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X a Focused Evaluation of Single-Unit Plasma Transfusions in a Tertiary Focused Evaluation of Single-Unit Plasma Transfusions 0 in a Tertiary Care Academic Medical Center x AU SAINT LOUIS Thomas Fay, M.D., Daniela Hermelin, M.D., Douglas Blackall, M.D., M.RH. PAT H 0 LOGY uNIVERSITY. DEPARTMENT Department of Pathology, Saint Louis University School of Medicine SMWT LOI iVNPYIflJfl INTRODUCTION 1 STUDY DESIGN a Blood utilization monitoring isa component of our institutional PBM program. Data for 2017 plasma transfusions were At Saint Louis University Hospital (SLUH), an academic, tertiary care facility, we extracted from our electronic health perform concurrent daily blood utilization reviews. record system During our audit, a surprising number of single-unit plasma transfusions were Inclusion Criteria identified in patients with normal coagulation values ‘All patients were adults (>18 years old) This study was performed to evaluate single-unit plasma transfusions in detail, Patients further subdivided into two groups; to identify opportunities to improve transfusion practice. patients with INR values s1.5 and patients with INR values >1.5 ‘Patients with INR values 1.5 were the RESULTS primary focus of this study •Additional study data collected included the transfusing clinical service, a post-transfusion . A total of 2,887 units of plasma were transfused in 2017. INR value obtained within 24 hours of criteria. 395(14%) were single-unit transfusions; 328(11%) met the inclusion transfusion (if available), and the probable 55 single-unit transfusions were associated with INR values 1.5. indication for transfusion S Surgical subspecialties and emergency medicine were the most common Exclusion Criteria: transfusing services. ‘Patients transfused with plasma in the A post-transfusion INR, when available, did not demonstrate a significant operating room or post-anesthesia care unit change from the pre-transfusion baseline. and The most common indications for transfusion included hypovolemia V MM pCONCLUSIONS it bleeding. See Results Diagram below S A daily audit revealed that single-unit plasma transfusion events are common. Surgical subspecialties and emergency medicine accounted for the majority of -V these transfusions. surgical .uhspariali.n i’d Total of 2,887 units 55 single-unit transfusion, em erg. n n edo ne These ikely represent inappropriate of plasma were associated vnth an wentsicd as the no,, fteç,r,t transfused INR value 1s on .rng prow en of vng!. transfusions and opportunities to improve FFPunns j practice institutionally. Though single-unit red cell and platelet transfusions represent desirabe practices, single-unit plasma transfusions are an ‘V -V undesirable quality improvement metric. 35 (14%) were 328(11%) Mail common indication, single-unit met the inclusion fortran, fusion included critnta hypovolemla and bleeding transfusions ______________________ _________________________——____________________________ _______________________________ ________________________ Prevalence, Correlates, and Impact of Primary Immunodeficiency in Hospitalized Patients with Hematologic Malignancies Sonia Mathew, MD; Kahee A. Mohammed, MD, MPH SAINT LOUIS UNIVERSITY Saint Louis University School of Medicine S BAC KG RU U N 0 RESULTS patienl . eva!uatin the correlate, ot PlO among patienlsw ith - ruble i. We,ghted character; tics of pati,nls with Hful, stratitied 69 PiO, rlat:<nWide In Sample. ruble a weighted multwaniale logIsl’< regreshlon g - . wIth immunodeflcienry are at increased risk of Patients primary (P101 sample. 20082004 - HM, Nationwide In patient 2008- 2014 developing hematological malignancies NM) no — - -- Onarall PlO PvaIxe Pealue • Malignancy is the second most common cause of dealh in children and adults 94194! (009) 00101861 oft3_95%C) 1081101- 60:51 0940 with PlO Male gendn 301001 56 3) 5801 51.9) Male 3ende, Age in meal (so) 9911695— 0.981 <.08) - nears, Aria sea.s,n.annso — 59.6<514 593<54.0 0362 outromes In -Racefelhnieity • There is paucity of data regarding the impart of PlO on short-term ace lhnici Black O1liOtb—043) <.081 hospitalized patients with NM tia<1 590841110) 528(51) <.081 H I Iispa,<x 4(131 8 90) 651 (6.6) <.083 - Q12°t?L.._._ tW 083 1519 -083) <.08) - III 1546 081 OBJECTIVES - Other 81508 2) (05.41 - Wbinp 3 08 18.8.,.,, ci white 319279 (6491 2254 (22 II < 083 I lmnhiu,en gomoebidity med.. • This sludy aImed to describe (he prevalence oh PlO, socio-demographlc rIm hauser comw hidilv Irdm — .Le%P correlates of PlO, and ttne impacl of PID on short-term outcomes in hospitalized! 0 63605(32?) 1113 110.11 <.083 patients wlltl NM. 83575(65) 15121)51) ‘.088 141)119 —IS?) <081 I 2 1110115 11811 1194(18.91 ‘.081 1611115 —176) <.080 - METHODS 13 2l9l52cI 510115581 <.081 !Iowltal ret me Hospital rflimt 0951080-0901 <.081 Data Source. Study Design, and Sample ‘P°! ilk1 Ill!) <‘ Midweal 1131112—121) <.081 — - 081 - 0.816 Data source: kIid,.esi 126898 dIN 210112?.8l Wed 10110%-IOU West 111120(189l 19% 119.01 <I Sw.th 308 I8e’;”eI The Nationwide Inpatient Sample (N(S) 2008—2013 198453.169) 3550)133) <081 Urban hospital 1211112-I 03) <.08) • Enconipasses 1,000 hospitals ill 44 slates Uphan bospatal 190419 ill 1 9221 (93 11 0082 CONCLUSIONS • Inrludes 8 million annual hospital discharges hole: 0N3:do Ill IesaUtlaIe; 108, Intent, anal. rang patients with NM. patients with PlO wele associated with Study design: (ross-sectional study Owral: he p,evalence ot PIP was 1 30 fleyalenreotPlOmnHM Among hospitalized having higher in-hospital mortality, longer hospital stay, and increased hospital Sample: PlO- IgA dof, 1gM del, (VIP, 5(10, hype, gM, 9.08 • 1(0-9 codes were used to identify patIents with NM and PlO hyper IgE. (GO, and others expenses The sample comprised of 537931 hospitalized patients (aged a 28 yearsl disparities in health and hospital outcomes across • The highes) prenl ence was among patients 3.0% I This study highlights Measures Is’ with CU, followed by All., and NHL 2.0% rare/ethnicity, geographic region, and other hospital level factors in PID patients 3.1% Outcome of interest: 1.1% 3.9% 0.0% Higher odd; of PlO were among male, young, 30% with I-tM Diagnosis of PID, and Impact of PlO on in’hospital mortality, length of white adults, those with higher comor biditieo, Strength: large sample size, ability to generalize findings to hospitalized patients hospital and average total hospital charges among patients with HM - liii.. stay, and those living in Midwest and South 01 ALL NHL MM HI AMI CML Independent variables: Weakness: coding errors1 linsited arcess 10 clinical information — Age, gender, rare, co-morbidities, hospital region, urban versus rural Table 3 Impact of PlO on ‘n-hospital mortality, length of hospital Slay, and total hospital charges in IMPLICATIONS & FUTURE DIRECTIONS hospital p3118101w ith HM. Na lance: de Inpatient sample. 2001 -2081 This study suggests the need so identify PID patients as lisk ot NM. A scoring system — Statistical Analysis Onaradelislan — OR (95% qj Peala. measure risk ran help to reduce mortality and heatthrare expenses. — < — to • Descriptive statistirs: chi scuare and Independent sample t tests In-hospilalmo,laity’ -- _1 liii 01—1.28) l P,olongelhpspiralslay’ - 11311 16-140) • A geeater understanding ot the pathways responsible (or (he increased risk of NM in • Multilevel hierarchiral logistIc regression mode) to create a predictive 0 — Inlal hespilul eha ig.t. neal (50) — 595081 el 563518 can reduce canceL -- model of the impact of PlO nma.,mlse00..,::9nae6andeeae.i.er,ts,eeclEMl PtD Is needed, especially if early treatment of PlO the rIsk of - Diagnostic Accuracy of The SLU AMSAD Scale for Depression in Non-Demented Elderly 1 1 1, 1, 1 Rita Khoury a Binu Chakkamparambil ‘,John Chibnall iayashree Rajamanickam Aneel Kumar George I Grossberg Department of Psychiatry and Behavioral Neuroscience, Saint Louis University SAINT LOUIS UNIVERSITY Results Receiver Operating Characteristic Curve .i\tialyses and Correlation of’ Introduction — Depression Scales with DSM-5 MDD Diagnosis Dewielivt Anaflaia The sarnipte had a meaa ISO) age Cl 73 5 (7 I) years. 56% In = 26) -were Area Under the Curve Sensitivity Speciftcity/ rho / I women 66% (n 44; were Caitcis an. and 66% (n = 3t had at least, high school aviv sigw&iant getatno depresses, recalls both Despite its nnnpad, (p-value): of education The me SLUMS scoes was 25 9 2 SI. For the depeessia., meass res w.oend.agnssed and underteated (I In the absence of specific dagnostic cntena the - DSM-5 (No vs. MDD) nwiaa scores were e 54.5) ram. 305-15. ‘5.6(11 4) rer tee MAciRs and 49(3 2t for Diagnostic and Statistical Mamial of Mental Disorders. Filth Eaton (DIM’S) cntena the SLU AMSAD The SW AMSAD evidenced adequate internet consistency rehablaly the gold Strela’d d:asostc loot for steele depression Given ffe asTenty represens (Mpha = 77) 30% (n = IS) of palers met 05)4-5 caitena for lCD isafTiosis fact that most etdeely patients receive mental health care in prenary care sessrps (2). Totat Score Nc vs. Any (Mild’ No-Mild vs. Mod- then real raeasr.g need to ness op pratci aagnostt fools to be med by Iflnwv (Continuous) Mod-Sev) Depression 5ev Depression Diaorsoflc Accuracy end correlations care practitioners. in the taihat 603 analysis. tutai Korea (contcoast vanables) for the 005-If. MADHI. AMSAD were evieated in relation to ne D5M-t desi gratian of No .94 1.93? .86/ .70 .79 I 1.0 / .57/ .53 .89 /93 I .86 /75 and 510 The Saint Louis University (SLU) AMSAD tool 5 a bnef (5-item) questionnaire MOD vs MOD AUC vatuen were unilonnty high (5 93), with conesponae5iy high tevets that wan recently developed to eciwen for late-life depression The 5 items reference (< .00t) (< .001) (< .001) of tensi beily .93)2nd spa citcly (a eat Opbmat cutoffs were 9, far GDS- it, ft. fur appetite mood steep, activity snd death ideation using simple tanguage and stating MAciRS ard 7+ mr SIM AMSAD The SLU AMSAD wss equivalent in SOS-ft and Previous research has supported its validity and reliability in cognitivety intad otder .94/93/80/ .70 .69 1.0/37/ .39 .85/.87/.83/ .66 sspenOr to MADRS in these analyses.
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