title: Transforming hemoglobin measurement in trauma patients: noninvasive spot check hemoglobin.
abstract: 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.
authors.affiliation: Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, AZ. Electronic address: bjoseph@surgery.arizona.edu.
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.affiliation: Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, AZ.
authors.forename: Viraj
authors.initials: V
authors.lastname: Pandit
authors.affiliation: Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, AZ.
authors.forename: Hassan
authors.initials: H
authors.lastname: Aziz
authors.affiliation: Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, AZ.
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.affiliation: Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, AZ.
authors.forename: Bardiya
authors.initials: B
authors.lastname: Zangbar
authors.affiliation: Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, AZ.
authors.forename: Andrew
authors.initials: A
authors.lastname: Tang
authors.affiliation: Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, AZ.
authors.forename: Terence
authors.initials: T
authors.lastname: O' Keeffe
authors.affiliation: Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, AZ.
authors.forename: Qasim
authors.initials: Q
authors.lastname: Jehangir
authors.affiliation: Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, AZ.
authors.forename: Kara
authors.initials: K
authors.lastname: Snyder
authors.affiliation: Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, AZ.
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006454:Hemoglobins / Q000032:analysis* / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010092:Oximetry / Q000295:instrumentation*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013053:Spectrophotometry; D014947:Wounds and Injuries / Q000097:blood*
chemical_list: D015415:Biomarkers; D006454:Hemoglobins