SynthesisPLoS neglected tropical diseases2021
The 20-minute whole blood clotting test (20WBCT) for snakebite coagulopathy-A systematic review and meta-analysis of diagnostic test accuracy.
Synthesis in PLoS neglected tropical diseases, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 24 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 2 syntheses or guidelines pooled it, 44 citations in OpenAlex.
- Pooled it
- A global core outcome measurement set for snakebite clinical trials.The Lancet. Global health · 2023Pooled it
- Bothrops jararaca snake venom: A reappraisal of its coagulant activity in humans, mice, and rats.PLoS neglected tropical diseases · 2026Article
- Association between the 20-minute whole blood clotting test and fibrinogen concentrations in green pit viper envenomations in Bangkok.PLoS neglected tropical diseases · 2026Article
- Article
- Molecular Mechanisms of Efficacy Variation in Antivenoms: Insights from a Malayan Pit Viper (Tropical medicine and infectious disease · 2025Article
- Article
- Exploring theResearch and practice in thrombosis and haemostasis · 2025Article
- Article
- Handheld Point-of-Care Devices for Snakebite Coagulopathy: A Scoping Review.Thrombosis and haemostasis · 2025Article
- Article
- Diagnosis of human envenoming by terrestrial venomous animals: Routine, advances, and perspectives.Toxicon: X · 2024Article
- The Chinese guideline for management of snakebites.World journal of emergency medicine · 2024Article
- Clinical Risk Factors Associated with Poor Outcomes in Snake Envenoming: A Narrative Review.Toxins · 2023Review
- [A global core outcome measurement set for snakebite clinical trials].Medecine tropicale et sante internationale · 2023Article
- Diagnostic characteristics of the 20-minute whole blood clotting test in detecting venom-induced consumptive coagulopathy following carpet viper envenoming.PLoS neglected tropical diseases · 2023Observational
- Challenges and Opportunities in Clinical Diagnostic Routine of Envenomation Using Blood Plasma Proteomics.Toxins · 2023Review
- The use of rotational thromboelastometry parameters in understanding the coagulopathy following hump-nosed viper (Hypnale spp) bites: a preliminary study.Tropical diseases, travel medicine and vaccines · 2023Article
- Comparing modified Lee and White method against 20-minute whole blood clotting test as bedside coagulation screening test in snake envenomation victims.The journal of venomous animals and toxins including tropical diseases · 2023Article
- Correction: The 20-minute whole blood clotting test (20WBCT) for snakebite coagulopathy-A systematic review and meta-analysis of diagnostic test accuracy.PLoS neglected tropical diseases · 2023Article
Corrections and comments
- Erratum issued
Authors and funding
15 authors at 8 institutions in 9 countries.
Funding
Abstract
backgroundThe 20-minute whole blood clotting test (20WBCT) has been used to detect coagulopathy following snakebite for almost 50 years. A systematic review and meta-analysis of the 20WBCT was conducted to evaluate the accuracy of the 20WBCT to detect coagulopathy, indicative of systemic envenoming. METHODS AND
findingsDatabases were searched from inception up to 09/12/2020 to identify studies that compared the 20WBCT and INR/fibrinogen on five or more subjects. Data was extracted from full-text articles by two reviewers using a predetermined form. Authors of 29 studies that lacked sufficient details in the manuscript were contacted and included if data meeting the inclusion criteria were provided. Included studies were evaluated for bias using a tailored QUADAS-2 checklist. The study protocol was prospectively registered on PROSPERO database (CRD42020168953). The searches identified 3,599 studies, 15 met the inclusion criteria and 12 were included in the meta-analysis. Data was reported from 6 countries and included a total of 2,270 patients. The aggregate weighted sensitivity of the 20WBCT at detecting INR >1.4 was 0.84 (CI 0.61 to 0.94), the specificity was 0.91 (0.76 to 0.97) and the SROC AUC was 0.94 (CI 0.91 to 0.96). The aggregate weighted sensitivity of the 20WBCT at detecting fibrinogen <100 mg/dL was 0.72 (CI 0.58 to 0.83), the specificity was 0.94 (CI 0.88 to 0.98) and the SROC AUC was 0.93 (0.91 to 0.95). Both analyses that used INR and fibrinogen as the reference test displayed considerable heterogeneity.
conclusionsIn the absence of laboratory clotting assays, the 20WBCT remains a highly specific and fairly sensitive bedside test at detecting coagulopathy following snakebite. However, clinicians should be aware of the importance of operator training, standardized equipment and the lower sensitivity of the 20WBCT at detecting mild coagulopathy and resolution of coagulopathy following antivenom.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.