Validation Study of the Transfusion Risk and Clinical Knowledge (TRACK) Tool in Cardiac Surgery Patients: A Retrospective Analysis

Abstract

Objective: The Transfusion Risk and Clinical Knowledge (TRACK) scoring system has been developed for predicting perioperative blood transfusions. However, the TRACK score needs to be validated externally in the US population. The primary objective of this study is to validate TRACK at the authors' institution.

Design: This study was a single-center retrospective analysis.

Setting: Operating room and intensive care units of academic medical center.

Participants: Adult cardiac surgery patients.

Interventions: The authors retrospectively queried all cardiac surgeries at the authors' institution between 2010 and 2015 from the Society of Thoracic Surgeons database. The TRACK scores were determined for all patients. The authors used receiver operating characteristic (ROC) curves to assess the discriminatory power of TRACK in predicting any perioperative, intraoperative, and postoperative transfusions. The maximum Youden's index was used to determine optimal cutoff scores for predicting perioperative transfusions.

Measurements and main results: The authors analyzed 2,776 cardiac surgery patients with 51.8% transfused perioperatively. The average TRACK score (mean ± standard deviation) in transfused versus non-transfused patients was 12.4 ± 7.2 versus 6.1 ± 5.4, respectively (p < 0.001). The area under the ROC curve was 0.768 (95% confidence interval 0.800-0.835, p < 0.001) for any perioperative transfusion. Optimal sensitivity (67%) and specificity (73%) for predicting any perioperative transfusions was achieved with a TRACK score cutoff of greater than or equal to 22 of 32.

Conclusion: This study demonstrates the validity of the TRACK score in predicting blood perioperative transfusions in cardiac surgery patients at the authors' institution. This study supports the external validity of TRACK and adds to its clinical utility by establishing cutoff scores for identifying patients at high risk of transfusion.

Keywords: blood transfusion; cardiac surgical procedures; transfusion medicine.