The 20-minute whole blood clotting test (20WBCT) for snakebite coagulopathy-A systematic review and meta-analysis of diagnostic test accuracy.
Background The 20-minute whole blood clotting test (20WBCT) has been used to detect coagulopathy following snakebite for almost 50 years. A systematic review and meta-analysis of the 20WBCT was conducted to evaluate the accuracy of the 20WBCT to detect coagulopathy, indicative of systemic envenoming...
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ftdoajarticles:oai:doaj.org/article:6f48a79dfe9a449887251e953ea331eb 2023-05-15T15:15:57+02:00 The 20-minute whole blood clotting test (20WBCT) for snakebite coagulopathy-A systematic review and meta-analysis of diagnostic test accuracy. Thomas Lamb Michael Abouyannis Sâmella Silva de Oliveira Rachana Shenoy K Tulasi Geevar Anand Zachariah Sanjib Kumar Sharma Navin Bhatt Mavuto Mukaka Eli Harriss David G Lalloo Elizabeth A Ashley Wuelton Marcelo Monteiro Frank Smithuis Michael Eddleston 2021-08-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0009657 https://doaj.org/article/6f48a79dfe9a449887251e953ea331eb EN eng Public Library of Science (PLoS) https://doi.org/10.1371/journal.pntd.0009657 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0009657 https://doaj.org/article/6f48a79dfe9a449887251e953ea331eb PLoS Neglected Tropical Diseases, Vol 15, Iss 8, p e0009657 (2021) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2021 ftdoajarticles https://doi.org/10.1371/journal.pntd.0009657 2023-01-29T01:25:55Z Background The 20-minute whole blood clotting test (20WBCT) has been used to detect coagulopathy following snakebite for almost 50 years. A systematic review and meta-analysis of the 20WBCT was conducted to evaluate the accuracy of the 20WBCT to detect coagulopathy, indicative of systemic envenoming. Methods and findings Databases were searched from inception up to 09/12/2020 to identify studies that compared the 20WBCT and INR/fibrinogen on five or more subjects. Data was extracted from full-text articles by two reviewers using a predetermined form. Authors of 29 studies that lacked sufficient details in the manuscript were contacted and included if data meeting the inclusion criteria were provided. Included studies were evaluated for bias using a tailored QUADAS-2 checklist. The study protocol was prospectively registered on PROSPERO database (CRD42020168953). The searches identified 3,599 studies, 15 met the inclusion criteria and 12 were included in the meta-analysis. Data was reported from 6 countries and included a total of 2,270 patients. The aggregate weighted sensitivity of the 20WBCT at detecting INR >1.4 was 0.84 (CI 0.61 to 0.94), the specificity was 0.91 (0.76 to 0.97) and the SROC AUC was 0.94 (CI 0.91 to 0.96). The aggregate weighted sensitivity of the 20WBCT at detecting fibrinogen <100 mg/dL was 0.72 (CI 0.58 to 0.83), the specificity was 0.94 (CI 0.88 to 0.98) and the SROC AUC was 0.93 (0.91 to 0.95). Both analyses that used INR and fibrinogen as the reference test displayed considerable heterogeneity. Conclusions In the absence of laboratory clotting assays, the 20WBCT remains a highly specific and fairly sensitive bedside test at detecting coagulopathy following snakebite. However, clinicians should be aware of the importance of operator training, standardized equipment and the lower sensitivity of the 20WBCT at detecting mild coagulopathy and resolution of coagulopathy following antivenom. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 15 8 e0009657 |
institution |
Open Polar |
collection |
Directory of Open Access Journals: DOAJ Articles |
op_collection_id |
ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Thomas Lamb Michael Abouyannis Sâmella Silva de Oliveira Rachana Shenoy K Tulasi Geevar Anand Zachariah Sanjib Kumar Sharma Navin Bhatt Mavuto Mukaka Eli Harriss David G Lalloo Elizabeth A Ashley Wuelton Marcelo Monteiro Frank Smithuis Michael Eddleston The 20-minute whole blood clotting test (20WBCT) for snakebite coagulopathy-A systematic review and meta-analysis of diagnostic test accuracy. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
Background The 20-minute whole blood clotting test (20WBCT) has been used to detect coagulopathy following snakebite for almost 50 years. A systematic review and meta-analysis of the 20WBCT was conducted to evaluate the accuracy of the 20WBCT to detect coagulopathy, indicative of systemic envenoming. Methods and findings Databases were searched from inception up to 09/12/2020 to identify studies that compared the 20WBCT and INR/fibrinogen on five or more subjects. Data was extracted from full-text articles by two reviewers using a predetermined form. Authors of 29 studies that lacked sufficient details in the manuscript were contacted and included if data meeting the inclusion criteria were provided. Included studies were evaluated for bias using a tailored QUADAS-2 checklist. The study protocol was prospectively registered on PROSPERO database (CRD42020168953). The searches identified 3,599 studies, 15 met the inclusion criteria and 12 were included in the meta-analysis. Data was reported from 6 countries and included a total of 2,270 patients. The aggregate weighted sensitivity of the 20WBCT at detecting INR >1.4 was 0.84 (CI 0.61 to 0.94), the specificity was 0.91 (0.76 to 0.97) and the SROC AUC was 0.94 (CI 0.91 to 0.96). The aggregate weighted sensitivity of the 20WBCT at detecting fibrinogen <100 mg/dL was 0.72 (CI 0.58 to 0.83), the specificity was 0.94 (CI 0.88 to 0.98) and the SROC AUC was 0.93 (0.91 to 0.95). Both analyses that used INR and fibrinogen as the reference test displayed considerable heterogeneity. Conclusions In the absence of laboratory clotting assays, the 20WBCT remains a highly specific and fairly sensitive bedside test at detecting coagulopathy following snakebite. However, clinicians should be aware of the importance of operator training, standardized equipment and the lower sensitivity of the 20WBCT at detecting mild coagulopathy and resolution of coagulopathy following antivenom. |
format |
Article in Journal/Newspaper |
author |
Thomas Lamb Michael Abouyannis Sâmella Silva de Oliveira Rachana Shenoy K Tulasi Geevar Anand Zachariah Sanjib Kumar Sharma Navin Bhatt Mavuto Mukaka Eli Harriss David G Lalloo Elizabeth A Ashley Wuelton Marcelo Monteiro Frank Smithuis Michael Eddleston |
author_facet |
Thomas Lamb Michael Abouyannis Sâmella Silva de Oliveira Rachana Shenoy K Tulasi Geevar Anand Zachariah Sanjib Kumar Sharma Navin Bhatt Mavuto Mukaka Eli Harriss David G Lalloo Elizabeth A Ashley Wuelton Marcelo Monteiro Frank Smithuis Michael Eddleston |
author_sort |
Thomas Lamb |
title |
The 20-minute whole blood clotting test (20WBCT) for snakebite coagulopathy-A systematic review and meta-analysis of diagnostic test accuracy. |
title_short |
The 20-minute whole blood clotting test (20WBCT) for snakebite coagulopathy-A systematic review and meta-analysis of diagnostic test accuracy. |
title_full |
The 20-minute whole blood clotting test (20WBCT) for snakebite coagulopathy-A systematic review and meta-analysis of diagnostic test accuracy. |
title_fullStr |
The 20-minute whole blood clotting test (20WBCT) for snakebite coagulopathy-A systematic review and meta-analysis of diagnostic test accuracy. |
title_full_unstemmed |
The 20-minute whole blood clotting test (20WBCT) for snakebite coagulopathy-A systematic review and meta-analysis of diagnostic test accuracy. |
title_sort |
20-minute whole blood clotting test (20wbct) for snakebite coagulopathy-a systematic review and meta-analysis of diagnostic test accuracy. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2021 |
url |
https://doi.org/10.1371/journal.pntd.0009657 https://doaj.org/article/6f48a79dfe9a449887251e953ea331eb |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 15, Iss 8, p e0009657 (2021) |
op_relation |
https://doi.org/10.1371/journal.pntd.0009657 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0009657 https://doaj.org/article/6f48a79dfe9a449887251e953ea331eb |
op_doi |
https://doi.org/10.1371/journal.pntd.0009657 |
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PLOS Neglected Tropical Diseases |
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8 |
container_start_page |
e0009657 |
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