- Title
- Comparison of bedside clotting tests for detecting venom-induced consumption coagulopathy following Sri Lankan viper envenoming
- Creator
- Wedasingha, Supun; Silva, Anjana; Siribaddana, Sisira; Seneviratne, Kanishka; Isbister, Geoffrey K.
- Relation
- NHMRC.1110343 http://purl.org/au-research/grants/nhmrc/1110343 & 1154503
- Relation
- Clinical Toxicology Vol. 60, p. 1328-1335
- Publisher Link
- http://dx.doi.org/10.1080/15563650.2022.2128816
- Publisher
- Taylor & Francis
- Resource Type
- journal article
- Date
- 2022
- Description
- Background: The whole blood clotting test (WBCT) is commonly used for diagnosing venom-induced consumption coagulopathy (VICC) in resource-poor settings. We aimed to investigate the diagnostic accuracy of the WBCT and capillary blood clotting test (CBCT) for detecting VICC in viper envenoming in Sri Lanka. Methods: All confirmed snakebites admitted to Teaching Hospital Anuradhapura from July 2020 to June 2021 were included. On admission, WBCTs after 15, 20 and 25 min observation times (WBCT-15, WBCT-20 and WBCT-25) and CBCT observed in 30 s intervals (CBCT-t), 5 and 10 min CBCT (CBCT-5 and CBCT-10) were done. Blood was collected simultaneously for prothrombin time (PT)/international normalized ratio (INR) and plasma fibrinogen. We defined VICC as an INR >1.5 (Incomplete VICC = INR>1.5 and complete VICC = ≥3.0). Results: A total of 272 confirmed snakebites (Russell’s viper[76], hump-nosed viper[89], non-venomous snakes[51] and unidentified bites[56]) were recruited (median age: 42 y [interquartile range: 30- 53 y]; 189 males [69%]). On admission, 82 (30%) had incomplete VICC (INR >1.5 and <3) and 77 (28%) had complete VICC (INR ≥3). Sixteen (6%) developed clinically apparent bleeding. The WBCT-15 had the best sensitivity of 47% for detecting VICC and 68% for complete VICC. The sensitivities of the WBCT-20, WBCT-25, CBCT-5 and CBCT-10 was 30–35%. The sensitivities of all tests were better in detecting complete VICC, VICC in Russell’s viper bites and more than 2 h post-bite. The WBCT-15 test had a sensitivity of 76% for VICC in confirmed Russell’s viper bites. For detection of VICC, CBCT-t had an an excellent sensitivity of 97%, but a poor specificity of 35% for an optimal cut-off of >6.25 min. Conclusion: WBCTs are poorly diagnostic for VICC in Russell’s viper and hump-nosed viper envenoming, missing up to two-thirds of patients for some tests. The WBCT-15 was the best test, improving for more severe VICC and greater than 2 h post-bite.
- Subject
- Sri Lanka; snakebite; viper envenoming; whole blood clotting tests; capillary blood clotting tests; venom-induced consumption coagulopathy
- Identifier
- http://hdl.handle.net/1959.13/1484484
- Identifier
- uon:51341
- Identifier
- ISSN:1556-3650
- Language
- eng
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