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Comparing modified Lee and White method against 20-minute whole blood clotting test as bedside coagulation screening test in snake envenomation victims

BACKGROUND: Twenty-minute whole blood clotting test (20WBCT) and Modified Lee and White (MLW) method are the most routinely employed bedside tests for detecting coagulopathic snake envenomation. Our study compared the diagnostic utility of MLW and 20WBCT for snakebite victims at a tertiary care hosp...

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Autores principales: Suseel, Appu, Abraham, Siju V., Paul, Sarah, Tomy, Maglin Monica Lisa, Rafi, Aboobacker Mohamed
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Centro de Estudos de Venenos e Animais Peçonhentos (CEVAP/UNESP) 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10278964/
https://www.ncbi.nlm.nih.gov/pubmed/37342654
http://dx.doi.org/10.1590/1678-9199-JVATITD-2022-0088
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author Suseel, Appu
Abraham, Siju V.
Paul, Sarah
Tomy, Maglin Monica Lisa
Rafi, Aboobacker Mohamed
author_facet Suseel, Appu
Abraham, Siju V.
Paul, Sarah
Tomy, Maglin Monica Lisa
Rafi, Aboobacker Mohamed
author_sort Suseel, Appu
collection PubMed
description BACKGROUND: Twenty-minute whole blood clotting test (20WBCT) and Modified Lee and White (MLW) method are the most routinely employed bedside tests for detecting coagulopathic snake envenomation. Our study compared the diagnostic utility of MLW and 20WBCT for snakebite victims at a tertiary care hospital in Central Kerala, South India. METHODS: This single-center study recruited 267 patients admitted with snake bites. 20WBCT and MLW were performed simultaneously at admission along with the measurement of Prothrombin Time (PT). The diagnostic utility of 20WBCT and MLW was determined by comparing the sensitivity (Sn), specificity (Sp), positive and negative predictive values, likelihood ratios, and accuracy at admission with an INR value > 1.4. RESULTS: Out of 267 patients, 20 (7.5%) patients had VICC. Amongst those who had venom-induced consumption coagulopathy (VICC), MLW was prolonged for 17 patients, (Sn 85% 95% confidence interval [CI]: 61.1-96.0) whereas 20WBCT was abnormal for 11 patients (Sn 55%, 95% CI: 32.04-76.17). MLW and 20WBCT were falsely positive for the same patient (Sp 99.6%, 95% CI: 97.4-99.9%). CONCLUSION: MLW is more sensitive than 20WBCT to detect coagulopathy at the bedside amongst snakebite victims. However, further studies are necessary for standardizing bedside coagulation tests in snakebite cases.
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spelling pubmed-102789642023-06-20 Comparing modified Lee and White method against 20-minute whole blood clotting test as bedside coagulation screening test in snake envenomation victims Suseel, Appu Abraham, Siju V. Paul, Sarah Tomy, Maglin Monica Lisa Rafi, Aboobacker Mohamed J Venom Anim Toxins Incl Trop Dis Research BACKGROUND: Twenty-minute whole blood clotting test (20WBCT) and Modified Lee and White (MLW) method are the most routinely employed bedside tests for detecting coagulopathic snake envenomation. Our study compared the diagnostic utility of MLW and 20WBCT for snakebite victims at a tertiary care hospital in Central Kerala, South India. METHODS: This single-center study recruited 267 patients admitted with snake bites. 20WBCT and MLW were performed simultaneously at admission along with the measurement of Prothrombin Time (PT). The diagnostic utility of 20WBCT and MLW was determined by comparing the sensitivity (Sn), specificity (Sp), positive and negative predictive values, likelihood ratios, and accuracy at admission with an INR value > 1.4. RESULTS: Out of 267 patients, 20 (7.5%) patients had VICC. Amongst those who had venom-induced consumption coagulopathy (VICC), MLW was prolonged for 17 patients, (Sn 85% 95% confidence interval [CI]: 61.1-96.0) whereas 20WBCT was abnormal for 11 patients (Sn 55%, 95% CI: 32.04-76.17). MLW and 20WBCT were falsely positive for the same patient (Sp 99.6%, 95% CI: 97.4-99.9%). CONCLUSION: MLW is more sensitive than 20WBCT to detect coagulopathy at the bedside amongst snakebite victims. However, further studies are necessary for standardizing bedside coagulation tests in snakebite cases. Centro de Estudos de Venenos e Animais Peçonhentos (CEVAP/UNESP) 2023-06-19 /pmc/articles/PMC10278964/ /pubmed/37342654 http://dx.doi.org/10.1590/1678-9199-JVATITD-2022-0088 Text en https://creativecommons.org/licenses/by/4.0/© The Author(s). 2023 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (https://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Suseel, Appu
Abraham, Siju V.
Paul, Sarah
Tomy, Maglin Monica Lisa
Rafi, Aboobacker Mohamed
Comparing modified Lee and White method against 20-minute whole blood clotting test as bedside coagulation screening test in snake envenomation victims
title Comparing modified Lee and White method against 20-minute whole blood clotting test as bedside coagulation screening test in snake envenomation victims
title_full Comparing modified Lee and White method against 20-minute whole blood clotting test as bedside coagulation screening test in snake envenomation victims
title_fullStr Comparing modified Lee and White method against 20-minute whole blood clotting test as bedside coagulation screening test in snake envenomation victims
title_full_unstemmed Comparing modified Lee and White method against 20-minute whole blood clotting test as bedside coagulation screening test in snake envenomation victims
title_short Comparing modified Lee and White method against 20-minute whole blood clotting test as bedside coagulation screening test in snake envenomation victims
title_sort comparing modified lee and white method against 20-minute whole blood clotting test as bedside coagulation screening test in snake envenomation victims
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10278964/
https://www.ncbi.nlm.nih.gov/pubmed/37342654
http://dx.doi.org/10.1590/1678-9199-JVATITD-2022-0088
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