The 20-minute whole blood clotting test (20WBCT) for snakebite coagulopathy-A systematic review and meta-analysis of diagnostic test accuracy

Autor: Eli Harriss, Rachana Shenoy K, Navin Bhatt, Sanjib Kumar Sharma, Tulasi Geevar, Frank Smithuis, Michael Abouyannis, Wuelton Marcelo Monteiro, Anand Zachariah, Thomas Lamb, David G. Lalloo, Sâmella Silva de Oliveira, Elizabeth A. Ashley, Mavuto Mukaka, Michael Eddleston
Přispěvatelé: Chippaux, Jean-philippe
Rok vydání: 2021
Předmět:
Physiology
RC955-962
Glycobiology
Conflicts of Interest
Snake Bites
Cardiovascular Medicine
Fibrinogen
Toxicology
Pathology and Laboratory Medicine
Biochemistry
Medical Conditions
Coagulopathy
Arctic medicine. Tropical medicine
Medicine and Health Sciences
Toxins
Snakebite
Research Integrity
Whole blood
Antivenins
Diagnostic test
Eukaryota
Snakes
Hematology
Research Assessment
Checklist
Squamates
Test (assessment)
Body Fluids
Infectious Diseases
Systematic review
Blood
Cardiovascular Diseases
Meta-analysis
Vertebrates
Blood Coagulation Tests
Public aspects of medicine
RA1-1270
Anatomy
medicine.drug
wd_410
Research Article
Neglected Tropical Diseases
medicine.medical_specialty
wa_950
Systematic Reviews
Science Policy
Toxic Agents
Cardiology
Research and Analysis Methods
Sensitivity and Specificity
Internal medicine
medicine
Humans
Animals
International Normalized Ratio
Blood Coagulation
Glycoproteins
Coagulation Disorders
business.industry
Venoms
Public Health
Environmental and Occupational Health
Organisms
Biology and Life Sciences
Reptiles
medicine.disease
Tropical Diseases
Amniotes
qy_410
business
Zoology
Zdroj: PLoS Neglected Tropical Diseases
Lamb, T, Abouyannis, M, De Oliveira, S S, Shenoy K., R, Geevar, T, Zachariah, A, Sharma, S K, Bhatt, N, Mukaka, M, Harriss, E, Lalloo, D G, Ashley, E A, Monteiro, W M, Smithuis, F, Eddleston, M & Chippaux, J (ed.) 2021, ' The 20-minute whole blood clotting test (20WBCT) for snakebite coagulopathy—A systematic review and meta-analysis of diagnostic test accuracy ', PLoS Neglected Tropical Diseases, vol. 15, no. 8, pp. e0009657 . https://doi.org/10.1371/journal.pntd.0009657
PLoS Neglected Tropical Diseases, Vol 15, Iss 8, p e0009657 (2021)
ISSN: 1935-2735
Popis: 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
Author summary Snakebite is a neglected tropical disease and responsible for an estimated 130,000 deaths per year. Coagulopathy is the commonest clinical manifestation of systemic snakebite envenoming and is indicative of a need for antivenom. The 20WBCT is a simple, cheap and quick bedside clotting test devised to detect coagulopathy after snakebite. The test is used widely and is incorporated in multiple national and WHO guidelines. However, following a publication questioning its diagnostic accuracy, there is a lack of consensus regarding its diagnostic accuracy and utility. In this review, we conclude that the 20WBCT is capable of detecting coagulopathy following snakebite with high specificity and acceptable sensitivity. Diagnostic test accuracy of the 20WBCT is improved when assessing for the presence of severe coagulopathy. Inclusion of data in this analysis from a variety of countries, make the findings widely applicable. However, the heterogeneity in study findings indicates the need for local assessment of external validity. The results of this study support the WHO guidelines that recommend its continued use in the absence of conventional laboratory clotting assays. Urgent efforts are required to identify an optimal method of detecting systemic snakebite envenoming and the response to treatment through pharmacokinetic and pharmacodynamic studies of venom and antivenom.
Databáze: OpenAIRE
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