Evaluation of point-of-care tests for diagnosis of disseminated intravascular coagulation in dogs admitted to an intensive care unit

Shane W. Bateman From the Departments of Clinical Studies (Bateman, Mathews, Abrams-Ogg), Pathobiology (Lumsden), and Biomedical Sciences (Johnstone), Ontario Veterinary College, University of Guelph, Guelph, ON, Canada NIG 2WI; and Department of Critical Care (Hillers), Hamilton General Division, Hamilton Civic Hospitals, 237 Barton St E, Hamilton, ON, Canada L8L 2X2.

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Karol A. Mathews From the Departments of Clinical Studies (Bateman, Mathews, Abrams-Ogg), Pathobiology (Lumsden), and Biomedical Sciences (Johnstone), Ontario Veterinary College, University of Guelph, Guelph, ON, Canada NIG 2WI; and Department of Critical Care (Hillers), Hamilton General Division, Hamilton Civic Hospitals, 237 Barton St E, Hamilton, ON, Canada L8L 2X2.

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Anthony C. G. Abrams-Ogg From the Departments of Clinical Studies (Bateman, Mathews, Abrams-Ogg), Pathobiology (Lumsden), and Biomedical Sciences (Johnstone), Ontario Veterinary College, University of Guelph, Guelph, ON, Canada NIG 2WI; and Department of Critical Care (Hillers), Hamilton General Division, Hamilton Civic Hospitals, 237 Barton St E, Hamilton, ON, Canada L8L 2X2.

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John H. Lumsden From the Departments of Clinical Studies (Bateman, Mathews, Abrams-Ogg), Pathobiology (Lumsden), and Biomedical Sciences (Johnstone), Ontario Veterinary College, University of Guelph, Guelph, ON, Canada NIG 2WI; and Department of Critical Care (Hillers), Hamilton General Division, Hamilton Civic Hospitals, 237 Barton St E, Hamilton, ON, Canada L8L 2X2.

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Ian B. Johnstone From the Departments of Clinical Studies (Bateman, Mathews, Abrams-Ogg), Pathobiology (Lumsden), and Biomedical Sciences (Johnstone), Ontario Veterinary College, University of Guelph, Guelph, ON, Canada NIG 2WI; and Department of Critical Care (Hillers), Hamilton General Division, Hamilton Civic Hospitals, 237 Barton St E, Hamilton, ON, Canada L8L 2X2.

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Thomas K. Hillers From the Departments of Clinical Studies (Bateman, Mathews, Abrams-Ogg), Pathobiology (Lumsden), and Biomedical Sciences (Johnstone), Ontario Veterinary College, University of Guelph, Guelph, ON, Canada NIG 2WI; and Department of Critical Care (Hillers), Hamilton General Division, Hamilton Civic Hospitals, 237 Barton St E, Hamilton, ON, Canada L8L 2X2.

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Objective

To evaluate the accuracy of point-of-care tests for the diagnosis of disseminated intravascular coagulation (DIC) in dogs and assess the correlation and agreement of results between point-of-care and laboratory tests in the evaluation of hemostatic function.

Design

Prospective case series.

Animals

59 critically ill dogs (affected dogs) with clinical signs of diseases known to predispose to DIC and 52 clinically normal dogs.

Procedures

Accuracy of the point-of-care tests (activated clotting time [ACT], estimated platelet count and number of schizocytes from a blood smear, plasma total solids [TS] concentration, and the protamine sulfate test) was evaluated, using receiver operating characteristic curves and likelihood ratios. A strategy, using likelihood ratios to calculate a post-test probability of DIC, was tested with 65% used as a threshold for initiation of treatment. Results of laboratory tests (coagulogram and plasma antithrombin III activity) were used as the standard for comparison in each dog.

Results

ACT and estimated platelet count provided the best accuracy for detection of DIC. The plasma TS concentration, schizocyte number, and protamine sulfate test had poor accuracy. The strategy using post-test probability of DIC identified 12 of 16 affected dogs that had DIC. Estimated platelet count was correlated and had acceptable clinical agreement with automated platelet count (r = 0.70). The plasma TS (r = 0.28) concentration and serum albumin (r = 0.63) concentration were not accurate predictors of plasma antithrombin III activity. The ACT did not correlate with activated partial thromboplastin time (r = 0.28).

Conclusions and Clinical Relevance

Strategic use of likelihood ratios from point-of-care tests can assist clinicians in making treatment decisions for dogs suspected to have DIC when immediate laboratory support is unavailable. (J Am Vet Med Assoc 1999;215:805–810)

Objective

To evaluate the accuracy of point-of-care tests for the diagnosis of disseminated intravascular coagulation (DIC) in dogs and assess the correlation and agreement of results between point-of-care and laboratory tests in the evaluation of hemostatic function.

Design

Prospective case series.

Animals

59 critically ill dogs (affected dogs) with clinical signs of diseases known to predispose to DIC and 52 clinically normal dogs.

Procedures

Accuracy of the point-of-care tests (activated clotting time [ACT], estimated platelet count and number of schizocytes from a blood smear, plasma total solids [TS] concentration, and the protamine sulfate test) was evaluated, using receiver operating characteristic curves and likelihood ratios. A strategy, using likelihood ratios to calculate a post-test probability of DIC, was tested with 65% used as a threshold for initiation of treatment. Results of laboratory tests (coagulogram and plasma antithrombin III activity) were used as the standard for comparison in each dog.

Results

ACT and estimated platelet count provided the best accuracy for detection of DIC. The plasma TS concentration, schizocyte number, and protamine sulfate test had poor accuracy. The strategy using post-test probability of DIC identified 12 of 16 affected dogs that had DIC. Estimated platelet count was correlated and had acceptable clinical agreement with automated platelet count (r = 0.70). The plasma TS (r = 0.28) concentration and serum albumin (r = 0.63) concentration were not accurate predictors of plasma antithrombin III activity. The ACT did not correlate with activated partial thromboplastin time (r = 0.28).

Conclusions and Clinical Relevance

Strategic use of likelihood ratios from point-of-care tests can assist clinicians in making treatment decisions for dogs suspected to have DIC when immediate laboratory support is unavailable. (J Am Vet Med Assoc 1999;215:805–810)

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