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

<h4>Background</h4>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...

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Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/6f48a79dfe9a449887251e953ea331eb
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spelling	oai:doaj.org-article:6f48a79dfe9a449887251e953ea331eb2021-12-02T20:23:41ZThe 20-minute whole blood clotting test (20WBCT) for snakebite coagulopathy-A systematic review and meta-analysis of diagnostic test accuracy.1935-27271935-273510.1371/journal.pntd.0009657https://doaj.org/article/6f48a79dfe9a449887251e953ea331eb2021-08-01T00:00:00Zhttps://doi.org/10.1371/journal.pntd.0009657https://doaj.org/toc/1935-2727https://doaj.org/toc/1935-2735<h4>Background</h4>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.<h4>Methods and findings</h4>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.<h4>Conclusions</h4>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.Thomas LambMichael AbouyannisSâmella Silva de OliveiraRachana Shenoy KTulasi GeevarAnand ZachariahSanjib Kumar SharmaNavin BhattMavuto MukakaEli HarrissDavid G LallooElizabeth A AshleyWuelton Marcelo MonteiroFrank SmithuisMichael EddlestonPublic Library of Science (PLoS)articleArctic medicine. Tropical medicineRC955-962Public aspects of medicineRA1-1270ENPLoS Neglected Tropical Diseases, Vol 15, Iss 8, p e0009657 (2021)
institution	DOAJ
collection	DOAJ
language	EN
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.
description	<h4>Background</h4>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.<h4>Methods and findings</h4>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.<h4>Conclusions</h4>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
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://doaj.org/article/6f48a79dfe9a449887251e953ea331eb
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The 20-minute whole blood clotting test (20WBCT) for snakebite coagulopathy-A systematic review and meta-analysis of diagnostic test accuracy.

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