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Agreement Between Serum Assays Performed in ED Point-of-Care and Hospital Central Laboratories

  • Author(s): Dashevsky, Meir
  • Barsky, Carol L
  • Taylor, Richard Andrew
  • Berstein, Steven L.
  • et al.
Abstract

Background: Point-of-care (POC) testing allows for more time-sensitive diagnosis and treatment in the ED than sending blood samples to the hospital central laboratory (CL). However, many ED patients have blood sent to both, either out of clinical custom, or because clinicians do not trust the POC values.

Objective: To examine the level of agreement between POC and CL values in a large cohort of ED patients.

Methods: In an urban, Level One ED that sees approximately 120,000 patients/year, all patients seen between March 1st, 2013 and October 1st, 2014 who had blood sent to POC and CL labs had levels of agreement measured between serum sodium, potassium, BUN, creatinine, and hematocrit. Data were extracted from the hospital's clinical information system.  Agreement was analyzed with the use of Bland-Altman plots, defining both 95% confidence intervals (CIs) and more conservative CIs based on clinical judgment.

Results: Out of 163,661 patients seen during the study period, 14,567 had blood samples sent both for POC and CL analysis. Using clinical criteria, the levels of agreement for sodium were 98.6% (within 5mg/dL), for potassium 90.7% (0.5 mmol/L), for BUN 89.0% (within 5 mg/dL), for creatinine 94.5% (within 0.3 mg/dL), for hematocrit 96.5% (within 5 g/dL).

Conclusion: Agreement between POC and CL values is excellent. Restricting the analysis to clinically important levels of agreement continues to show excellent agreement. The data suggest that sending a serum sample to the hospital CL for duplicate assays is unnecessary. This may result in substantial savings and shorter ED lengths of stay.

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