A recent study published in the American Journal of Obstetrics and Gynecology examined the use of Triton for blood loss monitoring during cesarean sections1. This study builds on existing evidence of the accuracy of Triton in a variety of clinical specialities. Several studies have been published within obstetrics, including a 2017 study published in the American Journal of Perinatology Reports2, that examined the accuracy of Triton in comparison with visual estimation and the Quantitative Blood Loss (QBL) method established by CMQCC. The study looked at 50 patients having cesarean deliveries and used a validated reference assay to compare the three methods.
The study, performed at Santa Clara Valley Medical Center, showed that traditional visual estimation of blood loss led to a majority of estimates of either 800ml or 1000ml (928ml+/- 261ml, R2 = .479), with little recognition of low and high blood loss cases. Gravimetric QBL fared slightly worse, with values appearing highly scattered (822+/-489ml, R2 = .304), leading to both severe overestimation and underestimation in certain cases. Triton performed strongly and demonstrated a realistic distribution of blood loss, particularly a greater number of low blood loss cases than previously thought. (572+/-334ml, R2 = .902)
The team at UTMB Galveston took an alternative approach to validating the accuracy of Triton in cesarean deliveries. Their study divided patients into two groups defined by the change in hemoglobin the next day after delivery. The study group contained patients that experienced a drop in hemoglobin of 2 g/dl or greater, with the remaining patients constituting the control group. Those patients within the study group should therefore represent higher blood loss cases, and significant differences in blood loss between the two groups should be observed. Below were the results.
The findings show that Triton estimates were reflective of change in hemoglobin, while visual estimates were not. Another important variable was the difference between the average blood loss for Triton versus visual estimation. The average blood loss estimated by Triton was 415.3ml (+/- 260.6ml), significantly lower than the average for visual estimation at 799.6ml (+/- 215.6ml). A similar pattern has been shown in several other datasets.
Whether accurate blood loss estimation with Triton can impact patient outcomes was not specifically studied, the authors stated, “Based on our findings, the Triton system will ultimately lead to proper and timely implementation of obstetric hemorrhage protocols and hopefully better maternal outcomes.” This statement is supported by a recently published 7,600 patient study from Mount Sinai that determined Triton led to improved care by facilitating earlier postpartum hemorrhage intervention. An overview of the study can be found HERE.
One key finding within the Mount Sinai data revolved around the ordering of lab tests to monitor hemoglobin postpartum. Mount Sinai adjusted their protocol to only order lab tests if the patient had experienced greater than 600ml of blood loss in a vaginal delivery and greater than 1,000ml in a cesarean delivery. This led to significant cost savings with no negative impact to patient care, and was a result that UTMB postulated in their study, stating “The Triton device was easy to use, intuitive, safe, and did not malfunction. Its accuracy in predicting a Hgb drop and its ability to provide real-time blood loss data as each data point is obtained highlights the potential usefulness of the Triton device for intraoperative monitoring. This will potentially allow earlier intervention instead of waiting for postoperative CBC results or blood loss estimates at the end of the case.”
Learn more about the UTMB study.