Rascoe Alexander S, Kavanagh Michael D, Breslin Mary A, Hu Emily, Vallier Heather A
Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.
J Orthop Trauma. 2020 May;34(5):e165-e169. doi: 10.1097/BOT.0000000000001677.
To evaluate a noninvasive hemoglobin measurement device in an orthopaedic trauma population.
Prospective.
Level 1 trauma center.
PATIENTS/PARTICIPANTS: One hundred five patients consecutively admitted to the orthopaedic trauma service after surgical treatment of fracture.
Transcutaneous hemoglobin (TcHgb) monitoring using the Masimo Pronto Pulse CO-Oximeter model with Rainbow SET Technology for spot TcHgb measurement.
TcHgb measurements and standard venipuncture hemoglobin (vHgb) were obtained. Patient preferences for each were recorded.
TcHgb measurements were obtained in 100 patients and compared with their corresponding vHgb measurements. The mean vHgb and TcHgb were 10.2 ± 1.9 g/dL and 11.2 ± 2.1 g/dL, respectively, and the mean difference was 1.1 ± 1.6 g/dL, which was statistically different from 0 (P < 0.001). In 76% of cases, the TcHgb device overestimated vHgb. In a subgroup of patients undergoing procedures with minimal expected blood loss (external fixators of knee or ankle, irrigation and debridement, or open reduction and internal fixation of ankle or calcaneal fractures), the mean difference between vHgb and TcHgb was 0.68 ± 1.6 g/dL (P = 0.06).
A preliminary study of TcHgb monitoring with the tested device as a potential screening mechanism to limit unnecessary blood draws showed statistical difference from vHgb; however, the mean bias 1.1 g/dL of hemoglobin was notably small. In a subgroup of patients undergoing procedures with minimal expected blood loss, the device may have merit. Larger studies are required to determine the clinical relevance of differences in measurements between the 2 methods.
Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
评估一种用于骨科创伤患者群体的无创血红蛋白测量设备。
前瞻性研究。
一级创伤中心。
患者/参与者：105例骨折手术治疗后连续入住骨科创伤服务科室的患者。
使用带有彩虹集技术的Masimo Pronto Pulse CO - 血氧饱和度仪进行经皮血红蛋白（TcHgb）监测，以进行即时TcHgb测量。
获取TcHgb测量值和标准静脉穿刺血红蛋白（vHgb）值。记录患者对每种方法的偏好。
100例患者获得了TcHgb测量值，并与相应的vHgb测量值进行比较。vHgb和TcHgb的平均值分别为10.2±1.9 g/dL和11.2±2.1 g/dL，平均差异为1.1±1.6 g/dL，与0有统计学差异（P<0.001）。在76%的病例中，TcHgb设备高估了vHgb。在预期失血极少的手术患者亚组（膝关节或踝关节外固定器、冲洗和清创术，或踝关节或跟骨骨折切开复位内固定术）中，vHgb和TcHgb之间的平均差异为0.68±1.6 g/dL（P = 0.06）。
以经测试的设备进行TcHgb监测作为限制不必要采血的潜在筛查机制的初步研究显示，与vHgb有统计学差异；然而，血红蛋白的平均偏差1.1 g/dL明显较小。在预期失血极少的手术患者亚组中，该设备可能有价值。需要更大规模的研究来确定两种方法测量差异的临床相关性。
诊断性二级。有关证据级别的完整描述，请参阅作者指南。
