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. 2018 May 8;2(5):e014.
doi: 10.5435/JAAOSGlobal-D-18-00014. eCollection 2018 May.

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

Philip D Nowicki  1 , Akunne Ndika  1 , John Kemppainen  1 , Jeffrey Cassidy  1 , Michael Forness  1 , Siddarth Satish  1 , Nabil Hassan  1
Affiliations

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

Philip D Nowicki et al. J Am Acad Orthop Surg Glob Res Rev. .

Abstract

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 (R2 = 0.88). A weaker correlation was noted between the gravimetric method and reference EBL (R2 = 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.

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Conflict of interest statement

Dr. Nowicki or an immediate family member serves as a paid consultant to Orthopediatrics and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons and the Pediatric Orthopaedic Society of North America. Mr. Satish or an immediate family member is an employee of and has stock or stock options held in Gauss Surgical. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Ndika, Dr. Kemppainen, Dr. Cassidy, Dr. Forness, and Dr. Hassan. Dr. Nowicki performed data collection and manuscript preparation. Dr. Ndika, Dr. Kemppainen, Dr. Cassidy, and Dr. Forness performed data collection. Mr. Satish performed data analysis and manuscript preparation. Dr. Hassan performed data collection, data analysis, and manuscript preparation.

Figures

Figure 1
Figure 1
A, Graph showing estimated blood loss (EBL) in sponges: the gravimetric method versus the assay (measured) method (R2 = 0.49). B, Graph showing EBL in sponges: the Triton scanning estimation versus the assay (measured) method (R2 = 0.88). ADJ, adjusted.
Figure 2
Figure 2
Graph showing the correlation of the visual estimate of the total blood loss with the assay (measured) method. The visual method overestimates blood loss at lower measured values and underestimates blood loss at higher measured values. EBL = estimated blood loss
See this image and copyright information in PMC

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References

    1. Levels of evidence are described in the table of contents. In this article, references 11, 12, and 13 are level I studies. References 2, 5, 8, 9, 10, 18, and 19 are level II studies. References 1, 3, 4, 6, 15, 20, 21, 22, 24, and 25 are level III studies. References 16, 23, 26, and 27 are level IV studies. References 7, 14, and 17 are level V studies.

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