Comparison of common perioperative blood loss estimation techniques: a systematic review and meta-analysis
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REVIEW PAPER
Comparison of common perioperative blood loss estimation techniques: a systematic review and meta‑analysis Lara Gerdessen1 · Patrick Meybohm1,2 · Suma Choorapoikayil1 · Eva Herrmann3 · Isabel Taeuber1 · Vanessa Neef1 · Florian J. Raimann1 · Kai Zacharowski1 · Florian Piekarski1 Received: 17 May 2020 / Accepted: 11 August 2020 © The Author(s) 2020
Abstract Estimating intraoperative blood loss is one of the daily challenges for clinicians. Despite the knowledge of the inaccuracy of visual estimation by anaesthetists and surgeons, this is still the mainstay to estimate surgical blood loss. This review aims at highlighting the strengths and weaknesses of currently used measurement methods. A systematic review of studies on estimation of blood loss was carried out. Studies were included investigating the accuracy of techniques for quantifying blood loss in vivo and in vitro. We excluded nonhuman trials and studies using only monitoring parameters to estimate blood loss. A meta-analysis was performed to evaluate systematic measurement errors of the different methods. Only studies that were compared with a validated reference e.g. Haemoglobin extraction assay were included. 90 studies met the inclusion criteria for systematic review and were analyzed. Six studies were included in the meta-analysis, as only these were conducted with a validated reference. The mixed effect meta-analysis showed the highest correlation to the reference for colorimetric methods (0.93 95% CI 0.91–0.96), followed by gravimetric (0.77 95% CI 0.61–0.93) and finally visual methods (0.61 95% CI 0.40–0.82). The bias for estimated blood loss (ml) was lowest for colorimetric methods (57.59 95% CI 23.88–91.3) compared to the reference, followed by gravimetric (326.36 95% CI 201.65–450.86) and visual methods (456.51 95% CI 395.19–517.83). Of the many studies included, only a few were compared with a validated reference. The majority of the studies chose known imprecise procedures as the method of comparison. Colorimetric methods offer the highest degree of accuracy in blood loss estimation. Systems that use colorimetric techniques have a significant advantage in the real-time assessment of blood loss. Keywords Blood loss estimation · Visual estimation · Gravimetric method · Patient blood management · Direct measurement · Colorimetric blood loss estimation
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10877-020-00579-8) contains supplementary material, which is available to authorized users. * Florian J. Raimann [email protected] 1
Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Theodor‑Stern‑Kai 7, 60590 Frankfurt am Main, Germany
2
Department of Anaesthesia and Critical Care, University Hospital Würzburg, Würzburg, Germany
3
Institute of Biostatistics and Mathematical Modelling, Department of Medicine, Goethe University, Frankfurt, Germany
Abbreviations Acrobat-NRSI A Cochrane
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