Transforming Hemoglobin Measurement in Trauma Patients: Noninvasive Spot Check Hemoglobin

BACKGROUND: Technological advances now allow for noninvasive Hbg measurements. Previous studies have reported on the efficacy of continuous noninvasive Hgb devices. Recently, a new device, Pronto-7, a spot check pulse CO-oximeter has become available. The aim of our study was to assess noninvasive Hgb measurement in trauma patients. METHODS: We performed a prospective cohort analysis of all trauma patients presenting to our Level I trauma center. Invasive Hgb and spot check Hgb measurements were obtained simultaneously at presentation. Spot check was measured 2 times with each invasive Hgb value. Normal Hgb was defined as >8 mg/dL. Spearman correlation and Bland-Altman analysis was performed. RESULTS: A total of 525 patients had attempted spot check Hgb measurements with a success rate of 86% (n = 450). A total of 450 invasive and 1,350 spot check Hgb measurements were obtained. Mean +/- SD age was 41 +/- 21 years, 74% were male, and mean Injury Severity Score was 21 +/- 13. Thirty-eight percent (n = 173) of patients had Hgb <= 8 mg/dL at presentation. Mean invasive Hgb was 11.5 +/- 4.36 g/dL, mean spot check Hgb 11.1 +/- 3.60 g/dL, and mean difference was 0.3 +/- 1.3 g/dL. Spot check Hgb values had strong correlation with invasive Hgb measurements (R-2 = 0.77; R = 0.86; p = 0.04) with 76% accuracy and 95.4% sensitivity. CONCLUSIONS: Spot check Hgb monitoring had excellent correlation with invasive Hgb measurements. Application of spot check has more clinical use as compared with previous continuous Hgb monitoring. This novel technology allows immediate and accurate Hgb measurements in trauma patients. ((C) 2015 by the American College of Surgeons)