alexa Bedside whole-blood clotting times: validity after snakebites.
Haematology

Haematology

Journal of Blood Disorders & Transfusion

Author(s): Punguyire D, Iserson KV, Stolz U, Apanga S, Punguyire D, Iserson KV, Stolz U, Apanga S

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Abstract BACKGROUND: Venomous snakebites contribute to morbidity and mortality throughout the world, most commonly in resource-poor areas, with about 2.5 million humans sustaining snakebites annually. Coagulopathy is a significant cause of both morbidity and mortality in these patients. In the absence of more sophisticated hematological studies or obvious physical findings, many clinicians must rely on whole-blood clotting times to assess whether their patients are coagulopathic. Alternative (bedside) methods to assess clotting times are often officially recommended and used, but have not been validated. OBJECTIVE: We assessed two bedside methods for measuring whole-blood clotting time after snakebites for their congruence with results from a hospital laboratory. METHODS: Over a 5-month period, 46 sequential patients presenting with a possible snakebite had blood drawn for bedside (using syringe and ceftriaxone bottle as containers) and laboratory whole-blood clotting tests. All three tests used ∼5 mL whole blood and looked for any clot formation within 20 min. RESULTS: Compared to the laboratory, the syringe method correctly classified the patients 84.7\% of the time (sensitivity 88.9\%; specificity 82.4\%). The bottle method correctly classified the patients 86.8\% of the time (sensitivity 83.3\%; specificity 90.0\%). Comparing the area under the Receiver Operator Characteristics curves shows that both the syringe and bottle methods do not differ in their discrimination for identifying clotting. CONCLUSIONS: Both the syringe and ceftriaxone bottle bedside clotting test methods appear to be accurate enough to help guide therapy after potential snake envenomations when formal laboratory testing is unavailable. Copyright © 2013 Elsevier Inc. All rights reserved. This article was published in J Emerg Med and referenced in Journal of Blood Disorders & Transfusion

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