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Quantification of the Deviation between Visual Blood Loss Estimation and Gauss Surgical's Triton System in Cesarean Deliveries
Abstract Number: T3B-4
Abstract Type: Original Research
Introduction: Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality. The incidence of PPH is increasing (1). Improving PPH-related outcomes has emerged as an important quality improvement goal. Poor outcomes in patients with obstetrical hemorrhage are usually related to delayed recognition. In addition, visual blood loss estimates are known to be inaccurate (2-3). The objective of this study was to compare visual blood loss estimates to quantified blood loss using the Gauss Surgical Triton system.
Methods: IRB approval and consent was obtained for 50 cesarean deliveries. The Gauss Surgical Triton System is a validated system for blood loss monitoring that utilizes two separate devices, the Triton monitor and the L&D scale, to quantify blood loss (4-6). The Triton OR monitor is a novel FDA-cleared mobile application on a tablet computer (iPad™), which enables the tablet camera to capture images of surgical laps and suction canisters then uses colorimetric image analysis algorithms and cloud-based machine learning to quantify hemoglobin (Hb) mass. The Triton L&D scale uses a Bluetooth connected scale to measure the mass of clots and other blood materials with pre-programmed dry-weights that allow for automatic calculation. Blood loss was measured using the Triton system and compared with visual estimates (VBL) via Bland-Altman analysis and two-sided paired t-test. OR staff were blinded to the Triton measurements.
Results: There was a 200 mL difference of between Triton and VBL estimates (p<0.0001). On average, anesthesia providers tended to overestimate blood loss in the ranges observed (Figure). Thirty nine percent of patients have a clinically relevant (>250ml) overestimation. Fewer than 1% of patients had a significant (<250ml) underestimation.
Discussion: Use of the Triton system results in a clinically relevant difference in EBL estimation. More accurate blood loss estimation with the Triton system may lead to reduced morbidity and costs. Further studies will be needed to determine if this system will lead to improved maternal outcomes.
1.Callaghan WM et al. Obstet Gynecol. 2010 Apr;202(4):353.e1-6.
2.Bose P et al. British Journal of Gynecology. 2006 Aug;113(8):919-24.
3.Schorn MN. J Midwifery Women’s Health. 2010 Jan-Feb;55(1):20-7
4.Konig G et al. Anesth Analg. 2014 Sept ; 119(3): 595–600
5.Holmes AA et al. Anesth Analg. 2014 Sept ; 119(3): 588–594
6.Sharareh B et al. Open Orthop J. 2015 Aug 31;9:422-6