The systematic use of evidence-based methodologies and technologies enhances shared decision-making in the 2018 International Consensus Conference on Patient Blood Management

Hans Van Remoortel; Kari Aranko; Markus M Mueller; Emmy De Buck; Dana Devine; Gilles Folléa; Patrick Meybohm; Pierre Tiberghien; Erica M Wood; Philippe Vandekerckhove; Erhard Seifried

doi:10.1111/vox.12852

The systematic use of evidence-based methodologies and technologies enhances shared decision-making in the 2018 International Consensus Conference on Patient Blood Management

Vox Sang. 2020 Jan;115(1):60-71. doi: 10.1111/vox.12852. Epub 2019 Nov 10.

Authors

Hans Van Remoortel¹, Kari Aranko^{2

3}, Markus M Mueller⁴, Emmy De Buck^{1

5}, Dana Devine⁶, Gilles Folléa⁷, Patrick Meybohm⁸, Pierre Tiberghien⁹, Erica M Wood^{10

11}, Philippe Vandekerckhove^{5

12}, Erhard Seifried^{2

4

10}

Affiliations

¹ Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross, Mechelen, Belgium.
² European Blood Alliance (EBA), Amsterdam, The Netherlands.
³ Finnish Red Cross Blood Service, Helsinki, Finland.
⁴ German Red Cross Blood Transfusion Service, Frankfurt/Main, Germany.
⁵ Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium.
⁶ Canadian Blood Services, Ottawa, ON, Canada.
⁷ Société Française de Transfusion Sanguine (SFTS), Paris, France.
⁸ Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt/Main, Germany.
⁹ Etablissement Français du Sang (EFS), Saint-Denis, France.
¹⁰ International Society of Blood Transfusion (ISBT), Amsterdam, The Netherlands.
¹¹ Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
¹² Belgian Red Cross, Mechelen, Belgium.

Abstract

Background and objectives: Patient Blood Management (PBM) aims to optimize the care of patients who might need a blood transfusion. The International Consensus Conference on PBM (ICC-PBM) aimed to develop evidence-based recommendations on three topics: preoperative anaemia, red blood cell transfusion thresholds and implementation of PBM programmes. This paper reports how evidence-based methodologies and technologies were used to enhance shared decision-making in formulating recommendations during the ICC-PBM.

Materials & methods: Systematic reviews on 17 PICO (Population, Intervention, Comparison, Outcomes) questions were conducted by a Scientific Committee (22 international topic experts and one methodologist) according to GRADE (Grades of Recommendation, Assessment, Development and Evaluation) methodology. Evidence-based recommendations were formulated using Consensus Development Conference methodology.

Results: We screened 17 607 references and included 145 studies. The overall certainty in the evidence of effect estimates was generally low or very low. During the ICC, plenary sessions (100-200 stakeholders from a range of clinical disciplines and community representatives) were followed by closed sessions where multidisciplinary decision-making panels (>50 experts and patient organizations) formulated recommendations. Two chairs (content-expert and methodologist) moderated each session and two rapporteurs documented the discussions. The Evidence-to-Decision template (GRADEpro software) was used as the central basis in the process of formulating recommendations.

Conclusion: This ICC-PBM resulted in 10 clinical and 12 research recommendations supported by an international stakeholder group of experts in blood transfusion. Systematic, rigorous and transparent evidence-based methodology in a formal consensus format should be the new standard to evaluate (cost-) effectiveness of medical treatments, such as blood transfusion.

Keywords: anemia; patient blood management; red cell components; transfusion.

Publication types

Congress

MeSH terms

Anemia / therapy*
Blood Transfusion / standards*
Erythrocyte Transfusion / standards*
Humans