The appropriateness of
albumin use and baseline
albumin usage patterns were studied. Institutional practice patterns regarding the use of
albumin were compared to criteria established by an independent expert panel. Fifty-three institutions, all of which were members of VHA or the University Health-System Consortium, participated in the evaluation. Investigators collected data over an eight-week period from the medical records, pharmacy records, and hospital billing data of adult (18 years of age or older) and pediatric (age 1-17 years) patients for whom
albumin was prescribed. Data collected included patient-specific information, the prescribing physician's specialty area, patient location (level of care) when
albumin was prescribed, primary reasons for prescribing
albumin, and details of
albumin use. Data were collected for 1649 adult and 23 pediatric patients.
Albumin was prescribed inappropriately in 57.8% and appropriately in 28.2% of adults; appropriateness of use was unknown in 14% of the patients reviewed. The most common indication for
albumin use was
hypotension/
hypovolemia (23.9%), followed by bypass-pump priming (16.3%), intradialytic blood pressure support (9.6%), and
serum albumin values less than 2 g/dL (8.6%).
Albumin was prescribed inappropriately 100% of the time when used for intradialytic blood pressure support, low
serum albumin values, and
acute respiratory distress syndrome. The most appropriate use of
albumin occurred in patients with postsurgical
hypotension and
hypovolemia (67.8%),
nephrotic syndrome (79.3%), non-
hemorrhagic shock (44.3%),
hemorrhagic shock (51.9%), and
cirrhosis and paracentesis (31.3%).
Albumin was inappropriately prescribed for 57.8% of adult patients and 52.2% of pediatric patients. The mean number of total grams used by patients receiving
albumin appropriately was similar to those patients inappropriately receiving
albumin.