Mohnke Katja, Smetiprach Julia, Paumen Yuri, Mildenberger Philipp, Komorek Yannick, Griemert Eva-Verena, Wittenmeier Eva
Department of Anesthesiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
J Clin Monit Comput. 2025 Feb;39(1):175-182. doi: 10.1007/s10877-024-01194-7. Epub 2024 Jul 20.
Preoperative anemia in children is a significant clinical concern requiring precise diagnosis. Although traditional blood sample collection is effective, it poses challenges because of children's aversion and technical difficulties. Therefore, this study explores the suitability of noninvasive hemoglobin measurements in children during preoperative anesthesia consultation. Noninvasive hemoglobin measurement (SpHb®; Masimo) in children aged ≤ 17 years was performed during preoperative anesthesia consultation and compared with laboratory hemoglobin (labHb) levels. SpHb was measured in 62 children (median age: 6 years, standard deviation [SD] ± 5.3) without adverse effects but was unsuccessful in one child. The bias, limits of agreement, and root mean square error between SpHb and labHb were 0.3, -2.26- +2.8, and 1.3 g/dl, respectively. LabHb demonstrated a significant regression relationship with R of 0.359. LabHb was associated with a negative effect on bias [- 0.443 (CI 95: - 0.591- - 0.153, P < 0.001)], i.e., SpHb tends to underestimate labHb for high labHb values. The retest reliability between two consecutive SpHb measurements was 0.727 (P < 0.001). Double measurement of SpHb, age, weight, sex, heart rate, and perfusion index had no significant effects on accuracy. Using SpHb, a specificity of 96.3% (95% confidence interval [CI 95]: 87.3%-99.5%) and a sensitivity of 57.1% (CI 95: 18.4%-90.1%) were observed. Based on adapted cut-off values for SpHb (age-dependent cut-off values plus 0.8 g/dl), a sensitivity of 100% (CI 95: 64.6%-100%) was achieved for the investigated study collective. SpHb measurement in children is a quick procedure. The accuracy of hemoglobin measurement is insufficient for the diagnosis of anemia. Thus, whether the calculated cut-off SpHb values of this study collective can be considered for anemia screening in pediatric patients undergoing preoperative anesthesia consultation should be confirmed. Trial registration number and date of registration: This prospective study was registered at ClinicalTrials.gov (NCT03586141).
儿童术前贫血是一个需要精确诊断的重要临床问题。尽管传统的血样采集有效，但由于儿童的抗拒和技术困难，它带来了挑战。因此，本研究探讨了术前麻醉咨询期间无创血红蛋白测量在儿童中的适用性。在术前麻醉咨询期间对年龄≤17岁的儿童进行无创血红蛋白测量（SpHb®；Masimo），并与实验室血红蛋白（labHb）水平进行比较。对62名儿童（中位年龄：6岁，标准差[SD]±5.3）进行了SpHb测量，未出现不良反应，但有一名儿童测量失败。SpHb与labHb之间的偏差、一致性界限和均方根误差分别为0.3、-2.26至+2.8和1.3 g/dl。LabHb显示出显著的回归关系，R为0.359。LabHb对偏差有负面影响[-0.443（95%置信区间[CI 95]：-0.591至-0.153，P<0.001）]，即对于高labHb值，SpHb往往低估labHb。两次连续SpHb测量之间的重测可靠性为0.727（P<0.001）。SpHb、年龄、体重、性别、心率和灌注指数的双重测量对准确性无显著影响。使用SpHb，观察到特异性为96.3%（95%置信区间[CI 95]：87.3%-99.5%），敏感性为57.1%（CI 95：18.4%-90.1%）。基于SpHb的适应性截断值（年龄依赖性截断值加0.8 g/dl），在所研究的群体中实现了100%的敏感性（CI 95：64.6%-100%）。儿童SpHb测量是一个快速的过程。血红蛋白测量的准确性不足以诊断贫血。因此，本研究群体计算出的SpHb截断值是否可用于术前麻醉咨询的儿科患者的贫血筛查，应予以确认。试验注册号和注册日期：这项前瞻性研究已在ClinicalTrials.gov（NCT03586141）注册。
