Outcome Studies

TritonTM has contributed to improving maternal care through early recognition of postpartum hemorrhage in labor and delivery rooms.

Rubenstein, et al. “Automated Quantification of Blood Loss versus Visual Estimation in 274 Vaginal Deliveries” American Journal of Perinatology 2020 Feb 12. [Epub ahead of print]

This prospective, blinded study of 274 vaginal delivery patients compared quantified blood loss (QBL) determined by the automated Triton QBL system with the clinician’s visual estimation of blood loss (EBL). Median QBL (339 mL [217–515]) was significantly greater than median EBL (300 mL [200–350]; p < 0.0001) and the correlation between EBL and QBL was poor (r = 0.520). Importantly, automated QBL recognized more patients with excessive blood loss than EBL. Detection of blood loss > 500 ml (QBL = 26.2%, EBL = 5.1%, p < 0.0001) and > 1,000 ml (QBL = 4.0%, EBL = 0%, p = 0.002) were both enhanced using QBL.

Hire, et al. “Effect of Quantification of Blood Loss on Activation of a Postpartum Hemorrhage Protocol and Use of Resources” Journal of Obstetric, Gynecologic & Neonatal Nursing 2020 Feb 8. [Epub ahead of print]

This study looked at 42 patients having cesarean delivery for whom a postpartum hemorrhage protocol was activated based on the visual estimation of blood loss > 1,000 ml to determine if quantification of blood loss as using by Triton would have resulted in fewer protocol activations. The Triton QBL measurement was made within 10 minutes following the surgery. Twenty four of the 42 cases (57%) would not have been classified as having postpartum hemorrhage using QBL and protocol activation and its’ associated cost would have been avoided.

Katz D, et al. “The association between the introduction of quantitative assessment of postpartum blood loss and institutional changes in clinical practice: an observational study”. Int J Obstet Anesth. 2019 May 13.

This retrospective study compared 3,807 patients using Triton for both cesarean and vaginal deliveries with 3,811 historical control patients at an academic center. Triton was fully incorporated into existing practices and PPH protocols and used both during delivery and postpartum. There was a lower median and wider range of blood loss with Triton (vaginal 258 mL [151–384] vs 300 mL [300–350]; cesarean 702 mL [501–857] vs 800 ml [800–900], P<0.001 for both) and hemorrhage recognition (blood loss > 1 L) increased using Triton (vaginal 2.2% vs 0.5%; cesarean 12.6% vs 6.4%, P<0.001 for both). For vaginal delivery the proportion of transfusions on the postpartum ward decreased (47% vs 71%, P=0.046) although the transfusion rate and dose did not change. This suggests that accurate recognition of blood loss led to earlier but not more transfusion. For cesarean delivery there was a significant decrease in the transfusion dose with Triton (P=0.043) and secondary uterotonic use was greater with Triton (vaginal 22% vs 17.3%, 22%, P<0.001; cesarean 7.0% vs 6.0%, P=0.177). A cost analysis demonstrated a 152% ROI for Triton.

Rubenstein, et al. "Clinical Experience with the Implementation of Accurate Measurement of Blood Loss During Cesarean Delivery: Influences on Hemorrhage Recognition and Allogeneic Transfusion" American Journal of Perinatology 2018; 35(07): 655-659

This 2781 patient study compared the outcomes of C-sections performed using traditional visual estimation versus those performed using the Triton system. Triton showed over 4x more hemorrhage recognition (>1000cc blood loss cases) yet resulted in significantly less blood use per transfusion. In addition, hospital stay was shorter for patients in whom Triton was used. The authors conclude that the use of the Triton system appeared to improve care, perhaps due to earlier recognition and treatment of postpartum hemorrhage.

Bernal N, et al. “Accurate Measurement of Intraoperative Blood Loss during Wound Excision Leads to More Appropriate Transfusion and Reduced Blood Utilization” Journal of Anesthesia & Clinical Research 2017, 8:11

This study in burn patients was focused on the potential impact of Triton on transfusion practice. The use of Triton (n=221) versus traditional visual blood loss estimation (n=178) significantly decreased the average dose of transfusion. Furthermore, transfusion decision making was more efficient as evidenced by fewer patients requiring multiple transfusion episodes and delayed postoperative transfusions.

Thurer R, et al. “Accurate Measurement of Intraoperative Blood Loss Improves Prediction of Postoperative Hemoglobin Levels” Journal of Anesthesia & Clinical Research 2017, 8:743

This analysis from the aforementioned burn study shows that postoperative day 1 hemoglobin levels are better predicted when using Triton to measure blood loss as compared to visual estimation. This potentially impacts proper transfusion decision-making surrounding surgery.

Muniz-Castro, et al. “How Does Blood Loss Relate to the Extent of Surgical Wound Excision?” Burns 2018; 44:1130-1134.

This study determined the relationship between blood loss measured by Triton and the excised area in 130 wound excision procedures. The results were compared to 105 procedures using visual estimation. The correlation between measured blood loss and the excised area was poor while visual estimates were more closely related to the extent of excision.The authors concluded that visual estimates are based on the size of excision rather than the actual amount of bleeding. The measured blood loss is not well correlated with the extent of excision and clinicians should use accurate measurement rather than visual estimates to guide care.