Quality of Evidence-Based Guidelines for Transfusion of Red Blood Cells and Plasma: A Systematic Review

Katerina Pavenski; Simon Stanworth; Mark Fung; Erica M Wood; Joanne Pink; Michael F Murphy; Heather Hume; Susan Nahirniak; Kathryn E Webert; Susano Tanael; Denise Landry; Nadine Shehata; International Collaboration for Transfusion Medicine Guidelines (ICTMG)

doi:10.1016/j.tmrv.2018.05.004

Quality of Evidence-Based Guidelines for Transfusion of Red Blood Cells and Plasma: A Systematic Review

Transfus Med Rev. 2018 Jun 1:S0887-7963(18)30017-8. doi: 10.1016/j.tmrv.2018.05.004. Online ahead of print.

Affiliations

¹ Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital, Toronto, ON, Canada. Electronic address: PavenskiK@smh.ca.
² National Health Service (NHS) Blood and Transplant & the Oxford National Institute for Health Research (NIHR) Biomedical Research Centre, Oxford University Hospitals & University of Oxford, Oxford, United Kingdom. Electronic address: Simon.Stanworth@nhsbt.nhs.uk.
³ The University of Vermont Health Network and University of Vermont, Burlington, VT, USA. Electronic address: Mark.Fung@uvmhealth.org.
⁴ Transfusion Research Unit, Monash University and Department of Clinical Haematology, Monash Health, Melbourne, VIC, Australia. Electronic address: Erica.Wood@monash.edu.
⁵ Australian Red Cross Blood Service, Kelvin Grove, QLD, Australia. Electronic address: JPink@redcrossblood.org.au.
⁶ National Health Service (NHS) Blood and Transplant & the Oxford National Institute for Health Research (NIHR) Biomedical Research Centre, Oxford University Hospitals & University of Oxford, Oxford, United Kingdom. Electronic address: Mike.Murphy@nhsbt.nhs.uk.
⁷ University of Montreal, Montreal, QC, Canada. Electronic address: Heather.Hume@umontreal.ca.
⁸ University of Alberta, Edmonton, AB, Canada. Electronic address: Susan.Nahirniak@albertahealthservices.ca.
⁹ McMaster University and Canadian Blood Services, Ancaster, ON, Canada. Electronic address: Kathryn.Webert@blood.ca.
¹⁰ Canadian Blood Services, Toronto, ON, Canada. Electronic address: Susano.Tanael@gmail.com.
¹¹ Canadian Blood Services, Ottawa, ON, Canada. Electronic address: DeniseC.Landry@blood.ca.
¹² Canadian Blood Services, Toronto, ON, Canada; Departments of Medicine and Laboratory Medicine and Pathobiology, Institute of Health Policy Management and Evaluation, Mount Sinai Hospital, Toronto, ON, Canada. Electronic address: Nadine.Shehata@sinaihealthsystem.ca.

PMID: 29921477
DOI: 10.1016/j.tmrv.2018.05.004

Abstract

Many transfusion guidelines are available, but little appraisal of their quality has been undertaken. The quality of guidelines may potentially influence adoption. Our aim was to determine the quality of evidence-based transfusion guidelines (EBG) for red cells and plasma, using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument, and assess duplication and consistency of recommendations. MEDLINE and EMBASE were systematically searched for EBG from 2005 to June 3, 2016. Citations were reviewed for inclusion in duplicate. A guideline was included if it had a specified clinical question, described a systematic search strategy, included critical appraisal of the literature and a description of how recommendations were developed. Four to six physicians used AGREE II to appraise each guideline. Median and scaled scores were calculated, with each item scored on a scale of one to seven, seven representing the highest score. Of 6174 citations, 30 guidelines met inclusion criteria. Twenty six guidelines had recommendations for red cells and 18 included recommendations for plasma use. The median score, the scaled score and the interquartile range of the scaled score were: scope and purpose: median score 5, scaled score 60%, IQR (49-74%); stakeholder involvement 4, 43%, (33-49%); rigor of development 4, 41%, (19-59%); clarity of presentation 5, 69%, (52-81%); applicability 1, 16%, (9-23%); editorial independence 3, 43%, (20-58%). Sixteen guidelines were evaluated to have a scaled domain score of 50% or less. Variations in recommendations were found for the use of hemoglobin triggers for red cell transfusion in patients with acute coronary syndromes and for plasma use for patients with bleeding. Our findings document, limited rigor in guideline development and duplication and inconsistencies in recommendations for the same topic. The process of developing guidelines for red cells and plasma transfusion can be enhanced to improve implementation.

Keywords: AGREE II; Guidelines; Plasma; Quality; Rbc.

Publication types

Review