Measurement of Intraoperative Blood Loss in Pediatric Orthopaedic Patients: Evaluation of a New Method

INTRODUCTION: Our goal was to validate a new method of intraoperative blood loss measurement in pediatric patients who undergo orthopaedic surgery. METHODS: We prospectively collected surgical sponges from 55 patients who underwent pediatric posterior spinal fusion, single-event multilevel surgery, or hip reconstruction for measurement of intraoperative blood loss. We enrolled patients if expected estimated blood loss (EBL) was >200 mL. The methods used for blood loss assessment included the Triton sponge scanning system, visual method, gravimetric method, and measured assay (reference) method. RESULTS: The Triton system calculation of cumulative EBL per patient against the reference method yielded a strong positive linear correlation (R(2) = 0.88). A weaker correlation was noted between the gravimetric method and reference EBL (R(2) = 0.49). The Triton system had a low bias and narrow limits of agreement relative to the reference method (49 mL; 95% CI, 30 to 68). The gravimetric method had a higher bias and wider limits of agreement (101 mL; 95% CI, 67 to 135). The comparison of visual total EBL against the reference method yielded a notable discrepancy. DISCUSSION: Estimated blood loss measured using the Triton system correlated better with the reference method than with the gravimetric method. The visual estimation method was found to be inaccurate. Intraoperative use of the Triton system is convenient and precise for monitoring intraoperative blood loss.