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



Lamb, Thomas, Abouyannis, Michael, de Oliveira, Samella Silva, Shenoy K., Rachana, Geevar, Tulasi, Zachariah, Anand, Sharma, Sanjib Kumar, Bhatt, Navin, Mukaka, Mavuto, Harriss, Eli
et al (show 8 more authors) (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, 15 (8). e0009657-.

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Abstract

<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.

Item Type: Article
Uncontrolled Keywords: Humans, Snake Bites, Fibrinogen, Antivenins, Blood Coagulation Tests, International Normalized Ratio, Sensitivity and Specificity, Blood Coagulation
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences
Depositing User: Symplectic Admin
Date Deposited: 14 Oct 2022 08:27
Last Modified: 18 Jan 2023 20:36
DOI: 10.1371/journal.pntd.0009657
Open Access URL: https://doi.org/10.1371/journal.pntd.0009657
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3165458