• Dustin G Mark, Jie Huang, Colleen Plimier, Mary E Reed, Gabriel J Escobar, David R Vinson, and Nareg H Roubinian.
• Department of Emergency Medicine, Kaiser Permanente Medical Center, 3600 Broadway, Oakland, CA 94611, USA; Department of Critical Care, Kaiser Permanente Medical Center, 3600 Broadway, Oakland, CA 94611, USA; Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA. Electronic address: Dustin.G.Mark@kp.org.
• Am J Emerg Med. 2020 Apr 1; 38 (4): 746-753.

Study ObjectiveTo assess trends over time in red blood cell (RBC) transfusion practice among emergency department (ED) patients with gastrointestinal (GI) bleeding within an integrated healthcare system, inclusive of 21 EDs.MethodsRetrospective cohort of ED patients diagnosed with GI bleeding between July 1st, 2012 and September 30th, 2016. The primary outcome was receipt of an RBC transfusion in the ED. Secondary outcomes included 90-day rates of RBC transfusion, repeat ED visits, rehospitalization, and all-cause mortality. Logistic regression was used to obtain confounder-adjusted outcome rates.ResultsA total of 24,868 unique patient encounters were used for the primary analysis. The median hemoglobin level in the ED prior to RBC transfusion decreased from 7.5 g/dl to 6.9 g/dl in the first versus last twelve months of the study period (p < 0.0001). A small trend was observed in the overall adjusted rate of ED RBC transfusion (absolute quarterly change of -0.1%, R2 = 0.18, p = 0.0001) largely attributable to the subgroup of patients with hemoglobin nadirs between 7.0 and 9.9 g/dl (absolute quarterly change of -0.4%, R2 = 0.38, p < 0.0001). Rates of RBC transfusions through 90 days likewise decreased (absolute quarterly change of -0.4%, R2 = 0.85, p < 0.0001) with stable to decreased corresponding rates of repeat ED visits, rehospitalizations and mortality.ConclusionRates of ED RBC transfusion decreased over time among patients with GI bleeding, particularly in those with hemoglobin nadirs between 7.0 and 9.9 g/dl. These findings suggest that ED providers are willing to adopt evidence-based restrictive RBC transfusion recommendations for patients with GI bleeding.Copyright © 2019 Elsevier Inc. All rights reserved.

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