Bryan Lightowler, Anthony Hoswell
Journal of Paramedic Practice, Vol. 8, Iss. 8, 05 Aug 2016, pp 396 - 406

Background: The aim of this review was to examine whether the measurement of
lactate in capillary blood samples using point-of-care handheld analysers corresponds
sufficiently closely with arterial and venous whole-blood samples analysed by
hospital central laboratory or blood gas analyser to be used interchangeably.

Methods: A systematic search, informed by focused inclusion/exclusion criteria,
was performed using multiple databases up to October 2015. A total of 65
articles were considered to have potential relevance and were evaluated in full
text, of which ultimately five articles met all inclusion/exclusion criteria, and a
final four were selected after data extraction and quality appraisal.

Results and Conclusion: All four studies found a predominantly upward bias in the
measurement of lactate in capillary samples tested using a handheld point-of-care
device over arterial or venous samples tested by laboratory methods or blood gas
analyser. In terms of correlation, there was consensus between the studies that the
strength of association between the two methods of measurement was statistically
significant. Three studies directly examined the extent of agreement between pointof-
care capillary lactate measurements and those of laboratory or blood gas analyser
reference determined to 2 standard deviations; 95% confidence intervals, and
report contextually broad limits of agreement, identifying a potential for both over
triage and, to a lesser extent, under triage. The findings of the review do not support
interchangeable use of handheld fingertip point-of-care lactate measurement with
laboratory or blood gas analyser methods in the identification of sepsis.

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