Michael Lintner Rivera, MD, MS
Pediatric Critical Care Global Health Fellow
University of Maryland School of Medicine
Baltimore, MD
Disclosure information not submitted.
Kevin Scott Gochenour, MD
Medical Student
University of Arizona College of Medicine - Phoenix
Phoenix, Arizona, United States
Disclosure information not submitted.
Meghan Hicks, MD
Pediatric Resident
Phoenix Children’s Hospital, Pediatric Residency Program
Phoenix, Arizona, United States
Disclosure information not submitted.
Robert Mannino, PhD
PhD
Parker H. Petit Institute for Bioengineering and Biosciences at Georgia Tech
Atlanta, Georgia, United States
Disclosure information not submitted.
Nicholas Huggins, MD
Pediatric Cardiac Intensivist
4. Division of Critical Care, Phoenix Children’s Hospital, Pediatric Cardiovascular Intensive Care Unit
Phoenix, Arizona, United States
Disclosure information not submitted.
Title: A Non-Invasive, Image-Based, Smartphone Application for Diagnosing Anemia in a Pediatric CVICU
Introduction: Patients Admitted to the Pediatric Cardiovascular Intensive Care Unit (CVICU) Frequently Require Blood Draws to Measure Hemoglobin (Hgb) Levels. Hemoglobin is Essential For Oxygen Delivery, And Thus, an Accurate Measurement of Hemoglobin is Essential in The Pediatric CVICU Where Patients With Congenital or Acquired Heart Disease May Not be Able to Increase Their Cardiac Output to Meet Their Oxygen Requirements. However, Frequent Sampling of Patients' Blood to Monitor Hemoglobin Levels is Not Without Complications, Including Pain From Venipuncture, Risk of Line Infection From Frequent Central Line Access, Cost of Laboratory Analysis, And Iatrogenic Anemia. In a Recent Study in 2018 by Mannino et al, Investigators Used an Image-Based, Smartphone Application (SA) to Non-Invasively Measure Patient's Hgb in an Outpatient Hematology Clinic. Our Study Aimed to Compare The Accuracy of This Application to Benchtop Complete Blood Count (CBC) Hgb in a Pediatric CVICU Setting.
Methods: A Prospective Cohort of Patients Admitted to our Pediatric CVICU in an Urban, Quaternary Pediatric Hospital From July to September 2020 Were Enrolled in The Study. Exclusion Criteria Included Patients With Nail Bed Injury, Leukonychia, Nail Bed Discoloration, or Patients For Whom Consent Was Not Obtained. Within 4 hours of Each CBC Hgb Collection the SA Hgb Was Obtained by Acquiring a Picture of The Patient’s Nail Beds From Within The Smartphone Application.
Results: The Mean Hemoglobin Measured by The Smartphone Photo Application (15.5 g/dL, Standard Deviation 1.79) Was 3.4 g/dL Higher Than The Mean Hemoglobin Measured by The Benchtop CBC (12.1g/dL, standard deviation 2.54). This Difference Was Statistically Significant [Paired t (73) = -12.9, p< 0.001]. Nevertheless, There Was a Strong Correlation Between The CBC And The Smartphone Application Measures of Hemoglobin [r (73) =.509, p< 0.001].
Conclusions: The Smartphone-Based Application Used to Non-Invasively Measure Patients’ Hemoglobin Levels in Our Pediatric CVICU Demonstrated Poor Accuracy And is an Unreliable Bedside Tool at This Time. However, The Application Showed Strong Correlation With The Benchtop CBC, And Further Research to Improve The Application's Performance Would Yield a Very Useful Tool For Clinicians Taking Care of Critically Ill Patients.