This study was done in a controlled environment and we sought to determine if the results are still accurate in real-time use in an emergency department. According to their study, they noted specifically that acetaminophen, acetylcysteine, ascorbate, bromide, creatine, glycolic acid, and hydroxyurea could affect their Chem8+ values. They also verified the precision of their system by testing multiple cartridges for 39 patient samples and showed the average creatinine difference across all reference ranges to be less than 0.04 mg/dL. They verified their machine’s accuracy using linear regression analysis which demonstrated correlations all greater than 0.985. According to data published on their website, the PoCT system, the Chem8+, designed by Abbott, Point of Care, Inc., was verified independently and approved for use by the FDA in 2006. It is important to determine the accuracy of PoCT testing in real time since inaccurate PoCT testing will impact patient care. Subjectively, many providers recall instances where the resulting i-Stat creatinine values were significantly different compared to the values from the central laboratory testing. If PoCT is as accurate as the IDMS from the central laboratory, using PoCT in these situations could allow the ED physician to quickly send a patient to CT scan for the appropriate study without delay.ĭuring the past 18 months, our department obtained over 724 PoCT chemistry studies. PoCT with a blood analyzer such as the i-Stat system is being used to provide real-time results in the ED within minutes. As an example, we feel that if we could use point-of-care testing (PoCT) rather than sending the samples to the central laboratory, this could expedite decision making in traumas and critical patients. During critical situations, obtaining the creatinine rapidly would allow the physician to determine the best diagnostic testing or therapy for a patient to prevent CIN. However, in reality, it can take even longer to obtain the value in a busy ED. Ideally, this test can take at least thirty minutes for the laboratory to analyze. It is important to rapidly identify patients who have elevated creatinine to risk-stratify patients before administrating iodinated contrast media.Ĭurrently, the gold standard to accurately measure creatinine in the emergency department (ED) is by isotope dilution mass spectrometry (IDMS) in a central laboratory. Creatinine value is an essential component when determining GFR. Previous studies have demonstrated that a glomerular filtration rate (GFR) <60 is a risk factor for CIN. Patients with preexisting renal impairment have an increased risk of developing CIN. Introduction/BackgroundĬontrast-induced nephropathy (CIN) is a known complication of procedures in which intravascular iodinated contrast media are administrated. We found a significant discrepancy between PoCT and IDMS creatinine values and found that this discrepancy could lead to improper risk stratification for CIN. This affected 30.1% of the total eligible sample population (22.9% to 37.3% with 95% CI). When using i-Stat creatinine values to calculate GFR, 47 out of 156 patients had risk category variations compared to using the IDMS value. 95% of the time, the IDMS creatinine value was variable and ranged from −0.45 mg/dL to +0.91 mg/dL when compared to the i-Stat creatinine. Mean IDMS creatinine values were 0.23 mg/dL higher when compared with i-Stat values. We included patients who presented to the department between March 2013 and September 2014 who had blood samples analyzed by both PoCT and IDMS. We conducted a descriptive retrospective chart review of patients seen in the Emergency Department of a single suburban, community, and academic medical center. To determine the accuracy of Point-Of-Care testing (PoCT) creatinine values when compared to standard central laboratory testing (IDMS) and to demonstrate if and how a discrepancy could lead to improper risk stratification for contrast induced nephropathy (CIN).
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |