20140905 hypotension systematic review
TRANSCRIPT
Are individuals presenting with hypotension eligible as whole blood donors?A systematic review
Nele Pauwels
Centre for Evidence-Based Practice
Donor selection prior to donation to protect the health of donor and recipient
− E.g. blood pressure measurement
No uniform donor selection criteria
− E.g. hemochromatosis patients
− E.g. individuals presenting with hypotension
Introduction
Pauwels NS, De Buck E, Compernolle V, Vandekerckhove P. Worldwide policies on haemochromatosis
and blood donation: a survey among blood services. Vox Sang. 2013, 105(2):121-128.
Belgian Red Cross-Flanders: donor management based on the best available scientific evidence
How to collect the evidence behind our donor health decisions?
Introduction
De Buck E, Pauwels NS, Dieltjens T, Vandekerckhove P. Use of evidence-based practice in an aid
organisation: a proposal to deal with the variety in terminology and methodology. Int J Evid Based Healthc.
2014, 12(1):39-49.
Systematic review
Methodology according to The Cochrane Collaboration
1. Formulation of the research question
2. Development of the search strategy and search in multiple databases
3. Evidence selection
4. Extraction and synthesis of the data
5. Quality assessment of the included studies and assignment of the levels of evidence (i.e. determination of bias, using the GRADE approach)
Systematic review
In blood donors presenting for whole blood donation, does hypotension increase the risk of donor adverse events when compared with normotension?
1. Research question
Systematic search in 5 databases
− from inception date until 12th April 2013
2. Search strategy
Systematic search in 5 databases
− using highly sensitive search strings
(“Blood Donors”[Mesh] OR blood don*[TIAB] OR “Blood Banks”[Mesh] OR blood bank*[TIAB] OR blood centre*[TIAB] OR blood center*[TIAB] OR blood service*[TIAB]) AND (“Hypotension”[Mesh:NoExp] OR hypotens*[TIAB] OR “Arterial Pressure”[Mesh] OR “blood pressure”[TIAB] OR “systolic pressure”[TIAB] OR “diastolic pressure”[TIAB] OR “Risk”[Mesh:NoExp] OR “Risk Factors"[Mesh] OR risk factor*[TIAB] OR “Risk Assessment”[Mesh:NoExp] OR “predonation”[TIAB] or “pre donation”[TIAB] OR “predictive”[TIAB] OR deferral*[TIAB] OR referral*[TIAB] OR inclusion*[TIAB] OR exclusion*[TIAB] OR “retention”[TIAB] OR retain*[TIAB] OR return*[TIAB] OR “first time”[TIAB] OR “Blood Volume”[Mesh:NoExp] OR “blood volume”[TIAB] OR “donor selection”[Mesh] OR “donation history”[TIAB] OR “donation status”[TIAB] OR “body weight”[Mesh:NoExp] OR “weight”[TIAB] OR “body mass index”[Mesh] OR “body mass index”[TIAB] OR “BMI”[TIAB]) AND (“Syncope”[Mesh] OR syncop*[TIAB] OR “vasovagal”[TIAB] OR “vaso vagal”[TIAB] OR “Unconsciousness”[Mesh:NoExp] OR unconscious*[TIAB] OR conscious*[TIAB] OR “Hypotension, Orthostatic”[Mesh] OR collaps*[TIAB] OR faint*[TIAB] OR convuls*[TIAB] OR "Bradycardia"[Mesh] OR “bradycardia”[TIAB] OR “Urinary Incontinence”[Mesh:NoExp] OR “Fecal Incontinence”[Mesh] OR “incontinence”[TIAB] OR “Sweating”[Mesh] OR “diaphoresis”[TIAB] OR “diaphoretic”[TIAB] OR “sweat”[TIAB] OR “sweaty”[TIAB] OR “sweating”[TIAB] OR “Dizziness”[Mesh] OR “dizzy”[TIAB] OR “dizziness”[TIAB] OR “light headedness”[TIAB] OR “lightheadedness”[TIAB] OR “Nausea”[Mesh:NoExp] OR “nausea”[TIAB] OR “nauseous”[TIAB] OR “vomit”[TIAB] OR “vomiting”[TIAB] OR “vomited”[TIAB] OR “weak”[TIAB] OR “weakened”[TIAB] OR “weakness”[TIAB] OR “Pallor”[Mesh] OR “pallor”[TIAB] OR “veins/injuries”[Mesh:NoExp] OR “Hematoma”[Mesh:NoExp] OR “hematoma”[TIAB] OR “haematoma”[TIAB] OR “Ecchymosis”[Mesh] OR “ecchymosis”[TIAB] OR “ecchymoses”[TIAB] OR “Contusions”[Mesh] OR “contusion”[TIAB] OR “contusions”[TIAB] OR “bruise”[TIAB] OR “bruises”[TIAB] OR “bruising”[TIAB] OR “nerve”[TIAB] OR side effect*[TIAB] OR “adverse”[TIAB] OR reaction*[TIAB] OR complication*[TIAB] OR “incident”[TIAB] OR “incidents”[TIAB] OR “safe”[TIAB] OR “safety”[TIAB])
2. Search strategy
3. Evidence selection
53 records (i.e. 45 peer-reviewed
publications and 9 conference
abstracts)
5418 records
(including peer-reviewed publications and conference abstracts)
Full text evaluation
Screening based on title and abstract evaluation
5365 irrelevant records excluded
Screening of reference list of included records
Reviewer 1
102 articles
Reviewer 2
8305 potentially relevant records identified:
CENTRAL (n= 93), MEDLINE (n= 1838),
Embase (n= 3757), CINAHL (n= 205)
Web Of Science (n= 2412)
9 records included in systematic review
(8 peer-reviewed publications and 1 conference abstract including 10 observational studies in total)
8 records selected
(i.e. 7 peer-reviewed publications and
1 conference abstract)
Full text evaluation
Screening of reference list of included records
Duplicate removal
2887 duplicates removed
Screening based on title and abstract evaluation
5379 irrelevant records excluded
39 records (i.e. 30 peer-reviewed
publications and 10 conference
abstracts)
8 records selected
(i.e. 7 peer-reviewed publications and
1 conference abstract)
4. Extract and synthesize data
Out of 8305 records, 10 observational studies were identified that addressed the question
Five of these studies (with a combined total of 1,482,020 donations and 2903 donors) included either a statistical analysis or an appropriate study design that controlled for possible confounding factors
Based on the currently available evidence, hypotension has not been shown to be an independent predictive factor for donor complications.
4. Extract and synthesise data
Overall quality of body of evidence
− ‘Low quality’ = further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
5. Quality assessment
INITIAL QUALITY LEVEL
RELATED TO STUDY DESIGN
LOW
Limitations of study design No major limitations
Imprecision No
Inconsistency No
Indirectness No
Publication bias No
QUALITY (GRADE) LOW
www.gradeworkinggroup.org
Publication
From evidence to recommendation: the Evidence-Based Practice approach
From evidence to recommendation: the Evidence-Based Practice approach
Discussion with team of experts and representatives of the target group
