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

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 Lalloo; Elizabeth A. Ashley; Wuelton Marcelo Monteiro; Frank Smithuisid; Michael Eddleston

doi:10.1371/journal.pntd.0009657

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

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 Lalloo, Elizabeth A. Ashley, Wuelton Marcelo Monteiro, Frank Smithuisid, Michael Eddleston

Research output: Contribution to journal › Article › peer-review

38 Citations (Scopus)

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 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.

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, 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.

Original language	English
Article number	e0009657
Pages (from-to)	e0009657
Journal	PLoS Neglected Tropical Diseases
Volume	15
Issue number	8
DOIs	https://doi.org/10.1371/journal.pntd.0009657
Publication status	Published - 10 Aug 2021

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10.1371/journal.pntd.0009657Licence: CC BY

Lamb et alFinal published version, 1.93 MBLicence: CC BY

38 Citations
1 Other contribution

Correction: The 20-minute whole blood clotting test (20WBCT) for snakebite coagulopathy—A systematic review and meta-analysis of diagnostic test accuracy
Lamb, T., Abouyannis, M., de Oliveira, S. S., Shenoy K., R., Geevar, T., Zachariah, A., Sharma, S. K., Bhatt, N., Mukaka, M., Harriss, E., Lalloo, D., Ashley, E. A., Monteiro, W. M., Smithuis, F. & Eddleston, M., 1 Jan 2023
Research output: Other contribution

Open Access
1 Citation (Scopus)

Cite this

Lamb, T., Abouyannis, M., de Oliveira, S. S., Rachana, S. K., Geevar, T., Zachariah, A., Sharma, S. K., Bhatt, N., Mukaka, M., Harriss, E., Lalloo, D., Ashley, E. A., Monteiro, W. M., Smithuisid, F., & Eddleston, M. (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. Article e0009657. https://doi.org/10.1371/journal.pntd.0009657

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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",

abstract = "BackgroundThe 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 findingsDatabases 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.ConclusionsIn 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.",

author = "Thomas Lamb and Michael Abouyannis and \{de Oliveira\}, \{S{\^a}mella Silva\} and Rachana, \{Shenoy K.\} and Tulasi Geevar and Anand Zachariah and Sharma, \{Sanjib Kumar\} and Navin Bhatt and Mavuto Mukaka and Eli Harriss and David Lalloo and Ashley, \{Elizabeth A.\} and Monteiro, \{Wuelton Marcelo\} and Frank Smithuisid and Michael Eddleston",

year = "2021",

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Lamb, T, Abouyannis, M, de Oliveira, SS, Rachana, SK, Geevar, T, Zachariah, A, Sharma, SK, Bhatt, N, Mukaka, M, Harriss, E, Lalloo, D, Ashley, EA, Monteiro, WM, Smithuisid, F & Eddleston, M 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, vol. 15, no. 8, e0009657, pp. e0009657. https://doi.org/10.1371/journal.pntd.0009657

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, Sâmella Silva et al.
In: PLoS Neglected Tropical Diseases, Vol. 15, No. 8, e0009657, 10.08.2021, p. e0009657.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - The 20-minute whole blood clotting test (20WBCT) for snakebite coagulopathy—A systematic review and meta-analysis of diagnostic test accuracy

AU - Lamb, Thomas

AU - Abouyannis, Michael

AU - de Oliveira, Sâmella Silva

AU - Rachana, Shenoy K.

AU - Geevar, Tulasi

AU - Zachariah, Anand

AU - Sharma, Sanjib Kumar

AU - Bhatt, Navin

AU - Mukaka, Mavuto

AU - Harriss, Eli

AU - Lalloo, David

AU - Ashley, Elizabeth A.

AU - Monteiro, Wuelton Marcelo

AU - Smithuisid, Frank

AU - Eddleston, Michael

PY - 2021/8/10

Y1 - 2021/8/10

N2 - BackgroundThe 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 findingsDatabases 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.ConclusionsIn 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.

AB - BackgroundThe 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 findingsDatabases 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.ConclusionsIn 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.

U2 - 10.1371/journal.pntd.0009657

DO - 10.1371/journal.pntd.0009657

M3 - Article

SN - 1935-2727

VL - 15

SP - e0009657

JO - PLoS Neglected Tropical Diseases

JF - PLoS Neglected Tropical Diseases

IS - 8

M1 - e0009657

ER -

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

Cite this