Validation of Postpartum Hemorrhage Admission Risk Factor Stratification in a Large Obstetrics Population.
Validation of Postpartum Hemorrhage Admission Risk Factor Stratification in a Large Obstetrics Population.
复制标题
在大量产科人群中对产后出血入院风险因素分层的验证
DOI：
10.1055/s-0040-1712166
复制
发表时间：
2021-09
影响因子：
2
通讯作者：
Escobar GJ
中科院分区：
文献类型：
--
作者：
Ruppel H;Liu VX;Gupta NR;Soltesz L;Escobar GJ
评价加州孕产妇质量护理协作（CMOCC）入院风险标准在大型产科人群中对产后出血风险进行分层的性能。使用详细的电子健康记录数据，我们根据CMQCC标准将2010年至2017年期间来自Kaiser Permanente北方加州医院的261，964例分娩住院分为高、中、低风险组。我们使用logistic回归评估CMQC CC风险组与产后出血之间的关联，使用两种不同的产后出血定义，标准产后出血（失血≥ 1，000 mL）和严重产后出血（基于输血，实验室和失血数据）。在低风险组中，我们还评估了其他入院因素与严重产后出血之间的关系。使用标准定义，产后出血发生在约5%的住院患者（n= 13，479）中，低风险组为3.2%，中等风险组为10.5%，高风险组为10.2%。824例（0.3%）住院患者发生严重产后出血，低危组发生率为0.2%，中危组为0.5%，高危组为1.3%。对于任一定义，与低风险组相比，中风险组和高风险组的产后出血几率显著较高。超过40%的产后出血发生在低风险的住院治疗中。在低风险组中，包括高血压和糖尿病在内的风险因素与严重产后出血的几率较高相关。我们发现，CMQCC入院风险评估标准通过增加我们样本中严重产后出血的发生率对妇女进行分层，这使得许多产后出血的早期准备成为可能。然而，CMQCC危险因素错过了相当大比例的产后出血。努力改善产后出血的风险评估使用目前入院的危险因素应考虑纳入其他非产科因素。
To evaluate the performance of the California Maternal Quality Care Collaborative (CMQCC) admission risk criteria for stratifying postpartum hemorrhage risk in a large obstetrics population. Using detailed electronic health record data, we classified 261,964 delivery hospitalizations from Kaiser Permanente Northern California hospitals between 2010 and 2017 into high, medium and low-risk groups based on CMQCC criteria. We used logistic regression to assess associations between CMQCC risk groups and postpartum hemorrhage using two different postpartum hemorrhage definitions, standard postpartum hemorrhage (blood loss ≥ 1,000mL) and severe postpartum hemorrhage (based on transfusion, laboratory and blood loss data). Among the low risk group, we also evaluated associations between additional present-on-admission factors and severe postpartum hemorrhage. Using the standard definition, postpartum hemorrhage occurred in about 5% of hospitalizations (n=13,479), with a rate of 3.2% in the low risk, 10.5% in the medium risk and 10.2% in the high risk group. Severe postpartum hemorrhage occurred in 824 hospitalizations (0.3%), with a rate of 0.2% in the low risk, 0.5% in the medium risk and 1.3% the high risk group. For either definition, the odds of postpartum hemorrhage were significantly higher in medium and high risk groups compared to the low risk group. Over 40% of postpartum hemorrhages occurred in hospitalizations that were classified as low risk. Among the low risk group, risk factors including hypertension and diabetes were associated with higher odds of severe postpartum hemorrhage. We found that the CMQCC admission risk assessment criteria stratified women by increasing rates of severe postpartum hemorrhage in our sample, which enables early preparation for many postpartum hemorrhages. However, the CMQCC risk factors missed a substantial proportion of postpartum hemorrhages. Efforts to improve postpartum hemorrhage risk assessment using present-on-admission risk factors should consider inclusion of other non-obstetrical factors.
登录
查看更多内容
影响因子：
7.2
作者：
Kuklina EV;Meikle SF;Jamieson DJ;Whiteman MK;Barfield WD;Hillis SD;Posner SF
通讯作者：
Posner SF
影响因子：
9.8
作者：
Dahlke, Joshua D.;Mendez-Figueroa, Hector;Rouse, Dwight J.
通讯作者：
Rouse, Dwight J.
影响因子：
2.9
作者：
Butwick, Alexander J.;Walsh, Eileen M.;Escobar, Gabriel J.
通讯作者：
Escobar, Gabriel J.
影响因子：
7.2
作者：
Einerson, Brett D.;Stehlikova, Zuzana;Clark, Erin A. S.
通讯作者：
Clark, Erin A. S.
影响因子：
3
作者：
Escobar, Gabriel J.;Gardner, Marla N.;Kipnis, Patricia
通讯作者：
Kipnis, Patricia