Advertisement

The increasing burden of phlebotomy in the development of anaemia and need for blood transfusion amongst trauma patients

      Abstract

      Background

      Diagnostic laboratory tests are an integral part of the management of trauma patients, however, may be responsible for significant iatrogenic blood loss. The purpose of this study was to examine how phlebotomy practises have changed over time, and to assess the impact of these practises on patient outcomes.

      Methods

      A continuous series of injured patients admitted to a level I trauma centre (March–April 2004) was compared to the same period in 2009. All diagnostic tests and blood volumes withdrawn for each patient were tabulated. Primary outcomes were in-hospital mortality and length of stay (LOS); secondary outcomes were development of anaemia (Hgb < 9 g/dl) and need for blood transfusion. A cost analysis was performed to determine the financial impact of the blood tests ordered.

      Results

      The 360 patients in 2009 and 384 patients in 2004 demonstrated no significant differences in demographics or clinical data. When outcomes were compared, there were no significant differences in hospital LOS, ICU LOS or mortality. From 2004 to 2009, the mean number of laboratory tests per patient increased significantly (21.2 ± 32.5 to 28.5 ± 44.4, p = 0.003). The total blood volumes drawn during the hospital stay also increased significantly (144.4 ± 191.2 ml to 187.3 ± 265.1 ml, p = 0.025). For ICU patients (329.7 ± 351.0 ml to 435.9 ± 346.3 ml, p = 0.048). There was a 25% increase in costs due to laboratory blood tests over the study period. For ICU patients, a 36% increase in costs was observed.

      Conclusions

      From 2004 to 2009, there was a significant increase in the utilisation of diagnostic laboratory tests in the management of the injured patient with no demonstrable improvements in mortality or LOS. Further prospective evaluation of these results is warranted.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Castro H.J.
        • Oropello J.M.
        • Halpern N.
        Point-of-care testing in the intensive care unit. The intensive care physician's perspective.
        Am J Clin Pathol. 1995; 10: S95-S99
        • Corwin H.L.
        • Parsonnet K.C.
        • Gettinger A.
        RBC transfusion in the ICU. Is there a reason?.
        Chest. 1995; 10: 767-771
        • Foulke G.E.
        • Harlow D.J.
        Effective measures for reducing blood loss from diagnostic laboratory tests in intensive care unit patients.
        Crit Care Med. 1989; 1: 1143-1145
        • Kumwilaisak K.
        • Noto A.
        • Schmidt U.H.
        • et al.
        Effect of laboratory testing guidelines on the utilization of tests and order entries in a surgical intensive care unit.
        Crit Care Med. 2008; 3: 2993-2999
        • Low L.L.
        • Harrington G.R.
        • Stoltzfus D.P.
        The effect of arterial lines on blood-drawing practices and costs in intensive care units.
        Chest. 1995; 10: 216-219
        • Muakkassa F.F.
        • Rutledge R.
        • Fakhry S.M.
        • et al.
        ABGs and arterial lines: the relationship to unnecessarily drawn arterial blood gas samples.
        J Trauma. 1990; 30 (discussion 1093–5): 1087-1093
        • Pilon C.S.
        • Leathley M.
        • London R.
        • et al.
        Practice guideline for arterial blood gas measurement in the intensive care unit decreases numbers and increases appropriateness of tests.
        Crit Care Med. 1997; 2: 1308-1313
        • Smoller B.R.
        • Kruskall M.S.
        Phlebotomy for diagnostic laboratory tests in adults. Pattern of use and effect on transfusion requirements.
        N Engl J Med. 1986; 31: 1233-1235
        • Solomon D.H.
        • Hashimoto H.
        • Daltroy L.
        • Liang M.H.
        Techniques to improve physicians’ use of diagnostic tests: a new conceptual framework.
        JAMA. 1998; 28: 2020-2027
        • Verstappen W.H.
        • van der Weijden T.
        • Sijbrandij J.
        • et al.
        Effect of a practice-based strategy on test ordering performance of primary care physicians: a randomized trial.
        JAMA. 2003; 28: 2407-2412