• Justyna Bartoszko, Duminda N Wijeysundera, Keyvan Karkouti, Jeannie Callum, Vivek Rao, Mark Crowther, Hilary P Grocott, Ruxandra Pinto, Damon C Scales, Blaine Achen, Sukhpal Brar, Doug Morrison, David Wong, Jean S Bussières, Tonya de Waal, Christopher Harle, Étienne de Médicis, Charles McAdams, Summer Syed, Diem Tran, Terry Waters, and Transfusion Avoidance in Cardiac Surgery Study Investigators.
• From the Department of Anesthesia and the Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada (J.B., D.N.W., K.K.) the Department of Anesthesia and Pain Management and the Peter Munk Cardiac Centre (D.N.W., K.K.) the Toronto General Research Institute (K.K.), Toronto General Hospital, University Health Network, Toronto, Ontario, Canada the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada (D.N.W.).
• Anesthesiology. 2018 Dec 1; 129 (6): 1092-1100.

What We Already Know About This TopicWHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Research into major bleeding during cardiac surgery is challenging due to variability in how it is scored. Two consensus-based clinical scores for major bleeding: the Universal definition of perioperative bleeding and the European Coronary Artery Bypass Graft (E-CABG) bleeding severity grade, were compared in this substudy of the Transfusion Avoidance in Cardiac Surgery (TACS) trial.MethodsAs part of TACS, 7,402 patients underwent cardiac surgery at 12 hospitals from 2014 to 2015. We examined content validity by comparing scored items, construct validity by examining associations with redo and complex procedures, and criterion validity by examining 28-day in-hospital mortality risk across bleeding severity categories. Hierarchical logistic regression models were constructed that incorporated important predictors and categories of bleeding.ResultsE-CABG and Universal scores were correlated (Spearman ρ = 0.78, P < 0.0001), but E-CABG classified 910 (12.4%) patients as having more severe bleeding, whereas the Universal score classified 1,729 (23.8%) as more severe. Higher E-CABG and Universal scores were observed in redo and complex procedures. Increasing E-CABG and Universal scores were associated with increased mortality in unadjusted and adjusted analyses. Regression model discrimination based on predictors of perioperative mortality increased with additional inclusion of the Universal score (c-statistic increase from 0.83 to 0.91) or E-CABG (c-statistic increase from 0.83 to 0.92). When other major postoperative complications were added to these models, the association between Universal or E-CABG bleeding with mortality remained.ConclusionsAlthough each offers different advantages, both the Universal score and E-CABG performed well in the validity assessments, supporting their use as outcome measures in clinical trials.

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