The SPOT GRADE

Spotnitz, William D.; Zielske, D.; Centis, Valerie; Hoffman, Rachel W; Gillen, Daniel L.; Wittmann, Catherine; Guyot, Vincent; Campos, Doris M.; Forest, Patricia; Pearson, Alan; McAfee, Paul C.

doi:10.1097/brs.0000000000002447

Cited by 20 publications

(4 citation statements)

References 35 publications

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“…Another notable gap in the current knowledge is how the flow of blood impacts visual blood loss estimations. Blood flow is one of the components used to assess the severity of surgical bleeding (Lewis et al, 2017;Spotnitz et al, 2018) and one of the criteria for determining if a trauma requires a tourniquet (Pons & Jacobs, 2017;Goolsby et al, 2018). Yet, in the studies included in our evaluation, blood flow was only mentioned in three, as part of the procedure.…”

Section: Discussionmentioning

confidence: 99%

Visual Blood Loss Estimation Accuracy: Directions for Future Research Based on a Systematic Literature Review

Phillips

Friberg

Cronqvist

et al. 2020

Proceedings of the Human Factors and Ergonomics Society Annual

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Visual blood loss estimation occurs in a variety of medical contexts and may impact everything from interventions by immediate responders to the likelihood of receiving blood transfusions in a hospital setting. However, research suggests that visual blood loss estimation is inaccurate for laypeople and medical professionals. The aim of the current study was to conduct a systematic literature review to determine the current state of knowledge on visual blood loss estimation accuracy and identify directions for future research. A structured search resulted in 1799 titles that were subsequently screened. A total of 72 articles were coded for comparison. Based on the evaluation, several gaps were identified, most notably related to factors of the situation that may influence estimation accuracy such as blood flow and victim/patient gender. Directions for future research are proposed based on identified gaps.

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Section: Discussionmentioning

confidence: 99%

Visual Blood Loss Estimation Accuracy: Directions for Future Research Based on a Systematic Literature Review

Phillips

Friberg

Cronqvist

et al. 2020

Proceedings of the Human Factors and Ergonomics Society Annual

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show abstract

“…Another surface estimation technique that was taught to medical professionals used videos that were calibrated to different flow rates and wound sizes. SPOT GRADE, a bleeding severity scale, was validated to express six levels of bleeding (none, minimal, mild, moderate, severe, and extreme) in a population of surgeons (n=14) (Spotnitz et al, 2018). The training consisted of 36 videos, which in the case of lay responders could be reduced if the goal to train was the threshold point of LTB.…”

Section: Discussionmentioning

confidence: 99%

“…Accepting SBEC's threshold recommendation of blood volume estimation of 6oz (≈175ml) to initiate immediate action to stop the bleeding, volume needs to be contextualized for learners. This may be communicated with a pedagogy that includes pictures, classroom manipulatives/visual aids, and videos (Cumming & Martinez-Taboada, 2020;Dildy et al, 2004;Merlin et al, 2009;Spotnitz et al, 2018;Toledo et al, 2010). These items should be authenticated to volume as well as contextual to situations in which learners might respond (ex.…”

Section: Discussionmentioning

confidence: 99%

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Systematic review of lay responders educational outcomes to identify life-threatening bleeding

Pellegrino¹,

Smith²,

Banton³

et al. 2021

IJFAE

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Pellegrino, et al. 2021 Creative Commons Attribution-NonCommercial 4.0 International License Objective: Identify evidence of how lay responders can accurately identify life-threatening bleeding (LTB) from educational interventions. Method: A systematic review process of the PubMed database to identify experimental and observational studies of educational interventions to identify LTB by lay responders. No exclusion regarding timeframe.Abstracts needed to be in English.Results: Three studies were identified, two with moderate risk of bias due to non-validation of measurement tool and one with a high risk of bias. All studies contributed to a notion that lay responders could identify a gross characteristic of LTB when presented visually.Implications: A gap exists in evidence to suggest lay responders can accurately distinguish LTB from non-LTB in the field or with distractions (e.g., clothing, porous surfaces). A valid means of measuring this learning outcomes would allow for future research to be reviewed and for meta-analysis for educational purposes to distinguish quality within and between programs. Secondarily, it may serve as a proxy for survival behaviors in the field, as application of tourniquets is still rare. Educationally, multiple representations of LTB in a localized context can be used (online or face-to-face) to raise awareness of characteristics of LTB for future identification.

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Variance estimation for the Kappa statistic in the presence of clustered data and heterogeneous observations

Ryan

Spotnitz

Gillen

2020

Statistics in Medicine

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We present a methodology motivated by a controlled trial designed to validate SPOT GRADE, a novel surgical bleeding severity scale. Briefly, the study was designed to quantify inter-and intra-surgeon agreement for characterizing the severity of surgical bleeds via a Kappa statistic. Multiple surgeons were presented with a randomized sequence of controlled bleeding videos and asked to apply the rating system to characterize each wound. Each video was shown multiple times to quantify intra-surgeon reliability, creating clustered data. In addition, videos within the same category may have had different classification probabilities due to changes in blood flow rates and wound sizes. In this work, we propose a new variance estimator for the Kappa statistic, for use in clustered data as well as heterogeneity among items within the same classification category. We then apply this methodology to data from the SPOT GRADE trial.

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The SPOT GRADE

Abstract: 2.

Cited by 20 publications

References 35 publications

Visual Blood Loss Estimation Accuracy: Directions for Future Research Based on a Systematic Literature Review

Visual Blood Loss Estimation Accuracy: Directions for Future Research Based on a Systematic Literature Review

Systematic review of lay responders educational outcomes to identify life-threatening bleeding

Variance estimation for the Kappa statistic in the presence of clustered data and heterogeneous observations

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