Heterogeneity was assessed in the results of the random-effects model by using the method described by Dias et al. <> Generated summaries of the evidence in NICE economic evidence profiles (included in the relevant chapter for each review question). However, in cases where standard deviations were not reported, the standard error was calculated if the p values or 95% CIs were reported and meta-analysis was undertaken with the mean and standard error using the generic inverse variance method in RevMan5. The full versions of all NICE guidance can be found at www.nice.org.uk. The PBM International Consensus Conference met in 2018 and evaluated key areas of the PBM field, including preoperative anemia, RBC transfusion thresholds, and implementation of PBM programs. The Guideline Development Group (GDG) noted the potential for side effects of oral iron, for example, nausea and gastric discomfort, and the risk of accidental overdose in children. It also shows the incremental costs, incremental effects (for example, quality-adjusted life years [QALYs]) and incremental cost-effectiveness ratio for the base case analysis in the evaluation, as well as information about the assessment of uncertainty in the analysis. 24). By providing access to this patient information, it is not the intention of NGC to provide specific medical advice for particular patients. When published data were not available, GDG expert opinion was used to populate the model. 4 0 obj Appendices. Baseline assessment tool. %���� The titles and abstracts of records retrieved by the searches were sifted for relevance, with potentially significant publications obtained in full text. Identifying Transfusion Strategies for Severely Injured Patients. Sensitivity analysis based on the quality of studies was also carried out, eliminating studies at overall high risk of bias (randomisation, allocation concealment and blinding, missing outcome data). For example, all RCTs started as High and the overall quality became Moderate, Low or Very low if 1, 2 or 3 points were deducted respectively. London (UK): National Institute for Health and Care Excellence; 2015 Nov. 8 p. (NICE guideline; no. To further the dissemination of transfusion and blood safety information, an app of the second edition of the Compendium was . Fresh frozen plasma transfusions may cause adverse outcomes in people who are critically ill, including transfusion-related acute lung injury, transfusion-related circulatory overload, multi-organ failure and an increased risk of infections. This NGC summary was completed by ECRI Institute on January 15, 2016. This guidance is subject to a 6-week public consultation and feedback as part of the quality assurance and peer review of the document. Some recommendations are 'strong' in that the GDG believes that the vast majority of healthcare and other professionals and patients would choose a particular intervention if they considered the evidence in the same way that the GDG has. Studies published in languages other than English were not reviewed. Some people have religious beliefs that do not allow the transfusion of blood. Literature reviews, posters, letters, editorials, comment articles, unpublished studies and studies not in English were excluded. Economic evaluations identified in the systematic literature search indicate that cell salvage and tranexamic acids are likely to be cost-effective individually compared with standard treatment (no intervention or placebo). Please refer to Appendix C in the full guideline appendices (see the "Availability of Companion Documents" field) for full details on the study design of studies selected for each review question. All searches were conducted in MEDLINE, EMBASE, and The Cochrane Library. The model was peer-reviewed by another health economist at the National Clinical Guideline Centre (NCGC). Healthcare professionals are expected to take National Institute for Health and Care Excellence (NICE) clinical guidelines fully into account when exercising their clinical judgement. Where possible, a meta-synthesis was conducted to combine qualitative study results. To facilitate this, binary outcomes were converted into absolute risk differences (ARDs) using GRADEpro software: the median control group risk across studies was used to calculate the ARD and its 95% CI from the pooled risk ratio. Firstly, the net benefit over harm (clinical effectiveness) was considered, focusing on the critical outcomes. Transfusion decisions should be based on clinical assessment and not on laboratory values alone. Where p values were reported as 'less than', a conservative approach was undertaken. <> Consider single-unit red blood cell transfusions for adults (or equivalent volumes calculated based on body weight for children or adults with low body weight) who do not have active bleeding. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. Summaries of evidence were generated by outcome (included in the relevant review chapters) and were presented in Guideline Development Group (GDG) meetings: Randomised studies: data were meta-analysed where appropriate and reported in Grading of Recommendations Assessment, Development, and Evaluation (GRADE) profiles (for intervention reviews). After each single-unit red blood cell transfusion (or equivalent volumes calculated based on body weight for children or adults with low body weight), clinically reassess and check haemoglobin levels, and give further transfusions if needed. Affiliations 1 German Red Cross Blood Transfusion Service and Goethe University Clinics, Frankfurt/Main, Germany. 24). Generally, the GDG considered for most of the outcomes in the intervention reviews that if at least 100 participants per 1000 (10%) achieved (if positive) the outcome of interest in the intervention group compared to the comparison group, then this intervention would be considered beneficial. Model inputs and assumptions were reported fully and transparently. As is the case for ordinary pairwise meta-analysis, NMA may be conducted using either fixed-effects or random-effects models. For some interventions, the GDG is confident that, given the information it has looked at, most patients would choose the intervention. Full papers were then obtained. 24). Estimated log odds ratios (with their 95% credible intervals) were calculated for comparisons of the direct and indirect evidence, The probability that each treatment was best, based on the proportion of Markov chain iterations in which each treatment had the highest probability of achieving the outcomes selected in the network(s), A ranking of treatments compared to baseline groups (presented as the median rank and its 95% credible intervals). Blood Transfusion welcomes international submissions of Original Articles, Review Articles and Letters on all the fields related to Transfusion Medicine. In these circumstances the recommendation is generally weaker, although it may be possible to make stronger recommendations about specific groups of patients. Guidelines International Network database (, National Institutes of Health Consensus Development Program (, National Health Service (NHS) Evidence Search (. A 20% sample of each of the above stages of the reviewing process was quality assured by a second reviewer to eliminate any potential of reviewer bias or error. However, for some outcomes this differed and was assessed on a case by case basis. Similar forms of words (for example, 'Do not offer…') are used when the GDG is confident that an intervention will not be of benefit for most patients. Two RCTs compared prophylactic platelet transfusion with no prophylactic platelet transfusion in adult haematology patients. The rating was then downgraded for the specified criteria: risk of bias (study limitations), inconsistency, indirectness, imprecision and publication bias. When all themes were extracted from studies, common concepts were categorised and tabulated. Studies that only reported cost per hospital (not per patient), or only reported average cost-effectiveness without disaggregated costs and effects, were excluded. Position Papers. ; 3 Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt/Main, Germany. 24). Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. Thus, if the evidence suggests that a strategy provides significant health benefits at an acceptable cost per patient treated, it should be recommended even if it would be expensive to implement across the whole population. These were assessed against the inclusion criteria. Consequently, aspects of quality assessment such as imprecision of effect could not be assessed for evidence of this type. National Clinical Guideline Centre. For more details about the assessment of applicability and methodological quality see the economic evaluation checklist (Appendix F of The guidelines manual and the health economics review protocol in Appendix D in the full guideline appendices). Staff from the NCGC provided methodological support and guidance for the development process. When we collect your data through site visits and account creation, we agree to never sell that information to third-parties. The questions, the study types applied, the databases searched and the years covered can be found in Appendix G in the full guideline appendices. National Guidelines on Appropiate Clinical Use of Blood. Moreover, the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes. At all subsequent GDG meetings, members declared arising conflicts of interest. As well as reviewing the published economic literature for each review question, new economic analysis was undertaken by the health economist in selected areas. It covers the general principles of blood transfusion, but does not make recommendations relating to specific conditions. Recommendations for adults in this guideline will generally apply to young people as well, but healthcare professionals should use their clinical judgement on when this is not appropriate for individual patients. Guideline Transfusion. Standards for Blood Banks and Transfusion Services for additional information and policies, especially in the areas of recipient sample identification, compatibility testing, issue and transfusion of blood and blood components, investigation of transfusion reactions, and proper record-keeping practices. Blood Transfusion Guideline, 2011 1 Table of contents Model inputs were based on the systematic review of the clinical literature supplemented with other published data sources where possible. Reassess the patient's clinical condition, repeat the fibrinogen level measurement and give further doses if needed. Guidelines on the use of irradiated blood components. The model with the smallest DIC is estimated to be the model that would best predict a replicate dataset which has the same structure as that currently observed. Do not routinely offer prophylactic platelet transfusions to patients with any of the following: Do not offer prophylactic platelet transfusions to patients having procedures with a low risk of bleeding, such as adults having central venous cannulation or any patients having bone marrow aspiration and trephine biopsy. London (UK): National Institute for Health and Care Excellence; 2015 Nov. 351 p. (NICE guideline; no. The GDG also discussed the relative importance of different outcomes when drafting the protocol for each review question and the outcomes were classified as critical or important. first launched in 2015, and thisnew app is now available for the Third Edition. This method tries to answer the question of what is the reasonable confidence interval of the log odds ratio of an outcome for the prediction of the confidence interval of the log odds ratio of the same outcome of a future trial of infinite size. For pairwise meta-analysis, a fixed effects model was used in the first instance. See Appendices F and I in the full guideline appendices for economic article selection and economic evidence tables. Refer to the original guideline document for details. Register Giving a patient the wrong blood transfusion is an avoidable serious hazard, and can result from errors made anywhere in the transfusion process. London (UK): National Institute for Health and Care Excellence (NICE); 2015 Nov 18. This type of analysis simultaneously compares multiple treatments in a single meta-analysis, preserving the randomisation of randomised controlled trials (RCTs) included in the reviews of direct comparisons trials. A blood transfusion is a way of adding blood to your body after an illness or injury. Specific issues relating to these people have been addressed when reviewing the evidence and writing the recommendations. Blood Transfusions for Patients with Acute Upper Gastrointestinal Bleeding. The GDG considered the 'strength' of recommendations. Further research is very likely to have an important impact on confidence in the estimate of effect and is likely to change the estimate. Identified potentially relevant studies for each review question from the economic search results by reviewing titles and abstracts. ) comprising Health professionals and researchers as well as to minimise blood loss are also discussed p. ( guideline. 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