Evaluation of a Pre-Filled Table and a Flowchart-Based Algorithm as Cognitive Aids to Reduce Deviations in Dose Calculation for Intraoperative Red Blood Cell Transfusions in Children—An International Web-Based Simulation
Background: Transfusion of red blood cell concentrate can be life-saving, but requires accurate dose calculations in children. Aims: We tested the hypothesis that cognitive aids would improve identification of the correct recommended volumes and products, according to the German National Transfusion...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-04-01
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| Series: | Children |
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| Online Access: | https://www.mdpi.com/2227-9067/10/5/815 |
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| author | Florian Piekarski Stephanie Noone Thomas Engelhardt Martin Hellmich Eva Wittenmeier Vinicius Quintao Philip Arnold Susan M. Goobie Kai Zacharowski Jost Kaufmann |
| author_facet | Florian Piekarski Stephanie Noone Thomas Engelhardt Martin Hellmich Eva Wittenmeier Vinicius Quintao Philip Arnold Susan M. Goobie Kai Zacharowski Jost Kaufmann |
| author_sort | Florian Piekarski |
| collection | DOAJ |
| description | Background: Transfusion of red blood cell concentrate can be life-saving, but requires accurate dose calculations in children. Aims: We tested the hypothesis that cognitive aids would improve identification of the correct recommended volumes and products, according to the German National Transfusion guidelines, in pediatric transfusion scenarios. Methods: Four online questionnaire-based scenarios, two with hemodynamically stable and two with hemodynamically unstable children, were sent to German and international pediatric anesthetists for completion. In the two stable scenarios, participants were given pre-filled tables that contained all required information. For the two emergency scenarios, existing algorithms were used and required calculation by the user. The results were classified into three categories of deviations from the recommended values (DRV): DRV120 (<80% or >120%), as the acceptable variation; DRV 300 (<33% or >300%), the deviation of concern for potential harm; and DRV 1000 (<10% or >1000%), the excessive deviation with a high probability of harm. Results: A total of 1.458 pediatric anesthetists accessed this simulation questionnaire, and 402 completed questionnaires were available for analysis. A pre-filled tabular aid, avoiding calculations, led to a reduction in deviation rates in the category of DRV120 by 60% for each and of DRV300 by 17% and 20%, respectively. The use of algorithms as aids for unstable emergencies led to a reduction in the deviation rate only for DRV120 (20% and 15% respectively). In contrast, the deviation rates for DRV300 and DRV1000 rose by 37% and 16%, respectively. Participants used higher transfusion thresholds for the emergency case of a 2-year-old compromised child than for the stable case with a patient of the same age (on average, 8.6 g/dL, 95% CI 8.5–8.8 versus 7.1 g/dL, 95% CI 7.0–7.2, <i>p</i> < 0.001) if not supported by our aids. Participants also used a higher transfusion threshold for unstable children aged 3 months than for stable children of the same age (on average, 8.9 g/dL, 95% CI 8.7–9.0 versus 7.9 g/dL, 95% CI 7.7–8.0, <i>p</i> < 0.001). Conclusions: The use of cognitive aids with precalculated transfusion volumes for determining transfusion doses in children may lead to improved adherence to published recommendations, and could potentially reduce dosing deviations outside those recommended by the German national transfusion guidelines. |
| first_indexed | 2024-03-11T03:50:40Z |
| format | Article |
| id | doaj.art-59ad60b873b24c2da202ed495aeb3825 |
| institution | Directory Open Access Journal |
| issn | 2227-9067 |
| language | English |
| last_indexed | 2024-03-11T03:50:40Z |
| publishDate | 2023-04-01 |
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| record_format | Article |
| series | Children |
| spelling | doaj.art-59ad60b873b24c2da202ed495aeb38252023-11-18T00:55:19ZengMDPI AGChildren2227-90672023-04-0110581510.3390/children10050815Evaluation of a Pre-Filled Table and a Flowchart-Based Algorithm as Cognitive Aids to Reduce Deviations in Dose Calculation for Intraoperative Red Blood Cell Transfusions in Children—An International Web-Based SimulationFlorian Piekarski0Stephanie Noone1Thomas Engelhardt2Martin Hellmich3Eva Wittenmeier4Vinicius Quintao5Philip Arnold6Susan M. Goobie7Kai Zacharowski8Jost Kaufmann9Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, 60590 Frankfurt, GermanyDepartment of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, 60590 Frankfurt, GermanyDepartment for Anesthesia, Montreal Children’s Hospital, Montreal, QC 1001, CanadaInstitute for Medical Statistics, Informatics, and Epidemiology (IMSIE), University Hospital Cologne, University of Cologne, 50923 Cologne, GermanyDepartment of Anesthesiology, University Medical Center of the Johannes Gutenberg-University, 55131 Mainz, GermanyDiscipline of Anesthesiology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, BrazilThe Jackson Rees Department of Anaesthesia, Alder Hey Children’s Hospital, Liverpool L12 2AP, UKDepartment of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children’s Hospital, Boston, MA 02115, USADepartment of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, 60590 Frankfurt, GermanyDepartment for Paediatric Anaesthesia, Children’s Hospital Cologne, 50735 Cologne, GermanyBackground: Transfusion of red blood cell concentrate can be life-saving, but requires accurate dose calculations in children. Aims: We tested the hypothesis that cognitive aids would improve identification of the correct recommended volumes and products, according to the German National Transfusion guidelines, in pediatric transfusion scenarios. Methods: Four online questionnaire-based scenarios, two with hemodynamically stable and two with hemodynamically unstable children, were sent to German and international pediatric anesthetists for completion. In the two stable scenarios, participants were given pre-filled tables that contained all required information. For the two emergency scenarios, existing algorithms were used and required calculation by the user. The results were classified into three categories of deviations from the recommended values (DRV): DRV120 (<80% or >120%), as the acceptable variation; DRV 300 (<33% or >300%), the deviation of concern for potential harm; and DRV 1000 (<10% or >1000%), the excessive deviation with a high probability of harm. Results: A total of 1.458 pediatric anesthetists accessed this simulation questionnaire, and 402 completed questionnaires were available for analysis. A pre-filled tabular aid, avoiding calculations, led to a reduction in deviation rates in the category of DRV120 by 60% for each and of DRV300 by 17% and 20%, respectively. The use of algorithms as aids for unstable emergencies led to a reduction in the deviation rate only for DRV120 (20% and 15% respectively). In contrast, the deviation rates for DRV300 and DRV1000 rose by 37% and 16%, respectively. Participants used higher transfusion thresholds for the emergency case of a 2-year-old compromised child than for the stable case with a patient of the same age (on average, 8.6 g/dL, 95% CI 8.5–8.8 versus 7.1 g/dL, 95% CI 7.0–7.2, <i>p</i> < 0.001) if not supported by our aids. Participants also used a higher transfusion threshold for unstable children aged 3 months than for stable children of the same age (on average, 8.9 g/dL, 95% CI 8.7–9.0 versus 7.9 g/dL, 95% CI 7.7–8.0, <i>p</i> < 0.001). Conclusions: The use of cognitive aids with precalculated transfusion volumes for determining transfusion doses in children may lead to improved adherence to published recommendations, and could potentially reduce dosing deviations outside those recommended by the German national transfusion guidelines.https://www.mdpi.com/2227-9067/10/5/815childrentransfusioncognitive aidsred blood cellsimulationblood loss |
| spellingShingle | Florian Piekarski Stephanie Noone Thomas Engelhardt Martin Hellmich Eva Wittenmeier Vinicius Quintao Philip Arnold Susan M. Goobie Kai Zacharowski Jost Kaufmann Evaluation of a Pre-Filled Table and a Flowchart-Based Algorithm as Cognitive Aids to Reduce Deviations in Dose Calculation for Intraoperative Red Blood Cell Transfusions in Children—An International Web-Based Simulation Children children transfusion cognitive aids red blood cell simulation blood loss |
| title | Evaluation of a Pre-Filled Table and a Flowchart-Based Algorithm as Cognitive Aids to Reduce Deviations in Dose Calculation for Intraoperative Red Blood Cell Transfusions in Children—An International Web-Based Simulation |
| title_full | Evaluation of a Pre-Filled Table and a Flowchart-Based Algorithm as Cognitive Aids to Reduce Deviations in Dose Calculation for Intraoperative Red Blood Cell Transfusions in Children—An International Web-Based Simulation |
| title_fullStr | Evaluation of a Pre-Filled Table and a Flowchart-Based Algorithm as Cognitive Aids to Reduce Deviations in Dose Calculation for Intraoperative Red Blood Cell Transfusions in Children—An International Web-Based Simulation |
| title_full_unstemmed | Evaluation of a Pre-Filled Table and a Flowchart-Based Algorithm as Cognitive Aids to Reduce Deviations in Dose Calculation for Intraoperative Red Blood Cell Transfusions in Children—An International Web-Based Simulation |
| title_short | Evaluation of a Pre-Filled Table and a Flowchart-Based Algorithm as Cognitive Aids to Reduce Deviations in Dose Calculation for Intraoperative Red Blood Cell Transfusions in Children—An International Web-Based Simulation |
| title_sort | evaluation of a pre filled table and a flowchart based algorithm as cognitive aids to reduce deviations in dose calculation for intraoperative red blood cell transfusions in children an international web based simulation |
| topic | children transfusion cognitive aids red blood cell simulation blood loss |
| url | https://www.mdpi.com/2227-9067/10/5/815 |
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