Publication: 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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Issued Date
2021-08-01
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ISSN
19352735
19352727
19352727
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2-s2.0-85114096676
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Mahidol University
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SCOPUS
Bibliographic Citation
PLoS Neglected Tropical Diseases. Vol.15, No.8 (2021)
Suggested Citation
Thomas Lamb, Michael Abouyannis, Sâmella Silva de Oliveira, Shenoy K. Rachana, Tulasi Geevar, Anand Zachariah, Sanjib Kumar Sharma, Navin Bhatt, Mavuto Mukaka, Eli Harriss, David G. Lalloo, Elizabeth A. Ashley, Wuelton Marcelo Monteiro, Frank Smithuisid, Michael Eddleston 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 (2021). doi:10.1371/journal.pntd.0009657 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/77985
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Title
The 20-minute whole blood clotting test (20wbct) for snakebite coagulopathy—a systematic review and meta-analysis of diagnostic test accuracy
Other Contributor(s)
Faculty of Tropical Medicine, Mahidol University
Edinburgh Medical School
B P Koirala Institute of Health Sciences
University of Peradeniya
University of Oxford
Liverpool School of Tropical Medicine
Mahosot Hospital, Lao
Nuffield Department of Medicine
Universidade do Estado do Amazonas
Christian Medical College, Vellore
Myanmar Oxford Clinical Research Unit
Tropical Medicine Foundation Dr. Heitor Vieira Dourado
Bayalpata Hospital
KEMRI-Wellcome Trust Collaborative Research Programme
Edinburgh Medical School
B P Koirala Institute of Health Sciences
University of Peradeniya
University of Oxford
Liverpool School of Tropical Medicine
Mahosot Hospital, Lao
Nuffield Department of Medicine
Universidade do Estado do Amazonas
Christian Medical College, Vellore
Myanmar Oxford Clinical Research Unit
Tropical Medicine Foundation Dr. Heitor Vieira Dourado
Bayalpata Hospital
KEMRI-Wellcome Trust Collaborative Research Programme
Abstract
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 suffi-cient 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, clini-cians 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 coagu-lopathy following antivenom.