References
Can handheld POC capillary lactate measurement be used with arterial and venous laboratory testing methods in the identification of sepsis?
Abstract
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 point-of-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.
Severe sepsis and septic shock are major causes of mortality and morbidity, with around 37 000 deaths and 100 000 hospital admissions reported annually within the United Kingdom (Gerber, 2010; Daniels, 2011). Current hospital coding systems hinder the accurate identification of mortality rates attached to sepsis syndrome, but estimates suggest such exceed those associated with myocardial infarction and stroke (Dombrovskiy et al, 2007; Daniels, 2011). Once a patient has developed septic shock, mortality rises by 7.6% for every hour antimicrobials are delayed, firmly establishing sepsis as a time-critical condition (Kumar et al, 2006).
Emergency department (ED) overcrowding is now a significant national challenge, with dwindling resources and increasing public demand causing departments to operate beyond capacity. The corollary to this is protracted waiting times, and delays in diagnosis, and the initiation of treatment plans (Perman et al, 2012; Rooney and Schilling, 2014). Around 46% of sepsis patients who are ultimately hospitalised are admitted via the ED, the majority (up to 80%) arriving by ambulance (Ginde and Moss, 2012; Berger et al, 2013; Gray et al, 2013).
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