Leading digit bias in hemoglobin thresholds for red cell transfusion.
Transfusion
; 64(5): 793-799, 2024 May.
Article
in En
| MEDLINE
| ID: mdl-38581269
ABSTRACT
BACKGROUND:
Leading digit bias is a heuristic whereby humans overemphasize the left-most digit when evaluating numbers (e.g., 9.99 vs. 10.00). The bias might affect the interpretation of hemoglobin results and influence red cell transfusion in hospitalized patients. STUDY DESIGN ANDMETHODS:
Adults who received a red cell transfusion while registered at the University Health Network (Toronto, Canada) between January 1, 2016 and January 1, 2022 (n = 6 years) were included. The primary analysis excluded apheresis, red cell disorders, radiology suites, and operating rooms. The primary comparison was a regression discontinuity analysis of transfusion occurrence above and below the hemoglobin threshold of 79 g/L (local units). Additional analyses tested other leading digit and control thresholds (71, 81, and 91 g/L). Secondary analyses explored temporal covariates and clinical subgroups.RESULTS:
A total of 211,872 red cell transfusions were identified over the study period (median pre-transfusion hemoglobin 76 g/L; interquartile range = 69-92 g/L), with 107,790 inpatient transfusions in the primary analysis. The 79 g/L threshold showed 815 fewer red cell units above the threshold (95% confidence interval [CI] -1215 to -415). The 69 g/L threshold showed 2813 fewer transfused units (95% CI -4407 to -1220), and 89 g/L showed 40 fewer units (95% CI -408 to 328). The effect was accentuated during daytime, weekday, and May-June months, persisted in analyses including all transfusions, and was absent at control thresholds.CONCLUSION:
Leading digit bias might have a modest influence on the decision to transfuse red cells. The findings may inform practice guidelines and quasi-experimental study design in transfusion research.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Hemoglobins
/
Erythrocyte Transfusion
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
America do norte
Language:
En
Journal:
Transfusion
Year:
2024
Document type:
Article
Affiliation country:
Canada
Country of publication:
United States