World Journal of Surgery

, Volume 37, Issue 3, pp 525–529

Continuous Noninvasive Hemoglobin Monitor from Pulse Ox: Ready for Prime Time?

  • Bellal Joseph
  • Pantelis Hadjizacharia
  • Hassan Aziz
  • Kara Snyder
  • Julie Wynne
  • Narong Kulvatunyou
  • Andrew Tang
  • Terence O’Keeffe
  • Rifat Latifi
  • Randall Friese
  • Peter Rhee
Article

Abstract

Background

Advances in technology have allowed for continuous noninvasive hemoglobin monitoring (SpHb), which may enable earlier detection of hemorrhage and more efficient surgical and/or blood transfusion management. The use of SpHb has not been described in the trauma population. The purpose of the present study was to evaluate the accuracy of a SpHb measurement device in severely injured trauma patients.

Methods

We performed a prospective cohort analysis of severely injured trauma patients admitted to the intensive care unit (ICU) at our level I trauma center over a 6 month period. Serial IHb (invasive hemoglobin) levels and SpHb for the first 72 h were measured. Each SpHb measurement was matched with a corresponding IHb measurement. We defined normal Hgb as >8 mg/dL and low Hgb as <8 mg/dL. Data were then grouped based on Hgb level. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and Spearman correlation coefficient plot were calculated.

Results

A total of 23 trauma patients with 89 data pairs were reviewed. Eighty-six percent of the patients were male with a mean age of 32 years and a mean injury severity score (ISS) of 21.1 ± 14. Invasive hemoglobin had a range of 7.2–16.9 and SpHb had a range of 3.3–15.2. The average mean and difference between IHb and SpHb were 10.7 and 1, respectively. Continuous noninvasive hemoglobin measurement did not record data points 13.5 % of the time. The Spearman correlation plot revealed a correlation of R = 0.670 (p < 0.001). After dichotomization with Hgb > 8, SpHb was found to have a sensitivity of 91 %, PPV 96 %, specificity 40 %, NPV 20 %, and an accuracy of 88 %.

Conclusions

The continuous noninvasive hemoglobin monitor does not appear to represent serum hemoglobin levels accurately in severely injured trauma patients. However, we were able to identify utility for this noninvasive tool when Hgb was dichotomized into normal or low levels.

References

  1. 1.
    Kauvar DS, Lefering R, Wade CE (2006) Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma 60:S3–S11PubMedCrossRefGoogle Scholar
  2. 2.
    Acosta JA, Yang JC, Winchell RJ et al (1998) Lethal injuries and time to death in a level I trauma center. J Am Coll Surg 186:528–533PubMedCrossRefGoogle Scholar
  3. 3.
    Shapiro NI, Kociszewski C, Harrison T et al (2003) Isolated prehospital hypotension after traumatic injuries: a predictor of mortality? J Emerg Med 25:175–179PubMedCrossRefGoogle Scholar
  4. 4.
    Bruns B, Lindsey M, Rowe K et al (2007) Hemoglobin drops within minutes of injuries and predicts need for an intervention to stop hemorrhage. J Trauma 63:312–315PubMedCrossRefGoogle Scholar
  5. 5.
    Shoemaker WC, Peitzman AB, Bellamy R et al (1996) Resuscitation from severe hemorrhage. Crit Care Med 24:S12–S23PubMedCrossRefGoogle Scholar
  6. 6.
    Gehring H, Hornberger C, Dibbelt L et al (2002) Accuracy of point of care testing (POCT) for determining hemoglobin concentrations. Acta Anaesthesiol Scand 46:980–986PubMedCrossRefGoogle Scholar
  7. 7.
    Mokken FC, van der Waart FJ, Henny CP et al (1996) Differences in peripheral arterial and venous hemorheologic parameters. Ann Hematol 73:135–137PubMedCrossRefGoogle Scholar
  8. 8.
    Yang ZW, Yang SH, Chen L et al (2001) Comparison of blood counts in venous, fingertip, and arterial blood and their measurement variation. Clin Lab Haem 23:155–159CrossRefGoogle Scholar
  9. 9.
    Macknet M, Norton S, Kimball-Jones P et al (2007) Continuous noninvasive measurement of hemoglobin via pulse CO-oximetry. Anesth Analg 105:S–108Google Scholar
  10. 10.
    Macknet MR, Allard M, Applegate RL II et al (2010) The Accuracy of noninvasive and continuous total hemoglobin measurement by pulse CO-oximetry in human subjects undergoing hemodilution. Anesth Analg 111:1424–1426PubMedCrossRefGoogle Scholar
  11. 11.
    Clarke JR, Trooskin SZ, Doshi PJ et al (2002) Time to laparotomy for intra-abdominal bleeding from trauma does affect survival for delays up to 90 min. J Trauma 52:420–425PubMedCrossRefGoogle Scholar
  12. 12.
    Gayat E, Bodin A, Sportiello C et al (2011) Performance evaluation of a noninvasive hemoglobin monitoring device. Ann Emerg Med 57:330–333PubMedCrossRefGoogle Scholar
  13. 13.
    Causey MW, Miller S, Foster A et al (2011) Validation of noninvasive hemoglobin measurements using the Masimo Radical-7 SpHb Station. Am J Surg 201:590–596CrossRefGoogle Scholar
  14. 14.
    Miller RD, Ward TA, Shiboski SC et al (2011) Comparison of three methods of hemoglobin monitoring in patients undergoing spine surgery. Anesth Analg 112:858–863PubMedCrossRefGoogle Scholar
  15. 15.
    Berkow L, Rotolo S, Mirski E (2011) Continuous noninvasive hemoglobin monitoring during complex spine surgery. Anesth Analg 113:1396–1402PubMedCrossRefGoogle Scholar
  16. 16.
    Butwick A, Hilton G, Carvalho B (2012) Non-invasive haemoglobin measurement in patients undergoing elective caesarean section. Br J Anaesth 108:271–277PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Bellal Joseph
    • 1
  • Pantelis Hadjizacharia
    • 1
  • Hassan Aziz
    • 1
  • Kara Snyder
    • 1
  • Julie Wynne
    • 1
  • Narong Kulvatunyou
    • 1
  • Andrew Tang
    • 1
  • Terence O’Keeffe
    • 1
  • Rifat Latifi
    • 1
  • Randall Friese
    • 1
  • Peter Rhee
    • 1
  1. 1.Department of SurgeryUniversity of ArizonaTucsonUSA

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