A Clinical Decision Support System for Preventing Adverse Reactions to Blood Transfusion

During 2011 approximately 21 million blood components were transfused in the United States, with roughly 1 in 414 resulting in complication. For Americans, the two leading causes of transfusion-related death are the respiratory complications Transfusion-related acute lung injury (TRALI) and Transfusion-associated circulatory overload (TACO). Each of these complications results in significantly longer ICU and hospital stays as well as significantly greater rates of mortality. We have developed a set of machine learning models for predicting the likelihood of these adverse reactions in surgical populations. Here we describe deploying these models into a perioperative critical care environment via a continuous monitoring and alerting clinical decision support system. The goal of this system, which directly integrates our suite of machine learning models running in the R statistical environment into a traditional health information system, is to improve transfusion-related outcomes in the perioperative environment. By identifying high-risk patients prior to transfusion, the clinical team may be able to choose a more appropriate therapy or therapeutic course. Identifying high-risk patients for increased observation after transfusion may also allow for a more timely intervention, thereby potentially improving care delivery and resulting patient outcome. An early prototype of this system is currently running in two Mayo Clinic perioperative environments.