Eisler et al reported a preoperative transfusion risk score which can help to identify a pediatric patient undergoing spinal fusion who will be transfused. The authors are from Columbia University and Texas Children's Hospital.
Patient selection: pediatric patient undergoing spinal fusion
Parameters:
(1) race
(2) sex
(3) age in years
(4) ASA status
(5) preoperative anemia
(6) hematologic disease (congenital or acquired; affecting plasma, platelets, leukocytes, red blood cells or marrow elements; probably other than just preoperative anemia)
(7) cardiac risk factors (congenital defects, arrhythmia, abnormal cardiac function)
(8) weight percentile in CDC growth chart
(9) neuromuscular disease
(10) number of levels fused
|
Parameter
|
Finding
|
Points
|
|
race
|
white
|
0
|
|
|
non-white
|
1
|
|
sex
|
male
|
0
|
|
|
female
|
1
|
|
age
|
< 12 years
|
2
|
|
|
>= 12 years
|
0
|
|
ASA status
|
I or II
|
0
|
|
|
III or IV
|
2
|
|
preoperative anemia
|
no
|
0
|
|
|
yes
|
2
|
|
hematologic disease
|
no
|
0
|
|
|
yes
|
2
|
|
cardiac risk
|
no
|
0
|
|
|
yes
|
2
|
|
weight
|
less than 3rd percentile
|
2
|
|
|
>= 3rd percentile
|
0
|
|
neuromuscular disease
|
no
|
0
|
|
|
yes
|
3
|
|
number of levels fused
|
< 13
|
0
|
|
|
>= 13
|
4
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 21
• The greater the score the greater the risk of perioperative blood transfusion.
|
Risk Score
|
Transfusion
|
|
0 to 3
|
9%
|
|
4 to 8
|
22-29%
|
|
9 to 12
|
48-50%
|
|
13 to 21
|
65-70%
|
Performance:
• The area under the ROC curve is 0.77.
