Poct chem 8 istat11/28/2023 Point-of-care thromboelastography/thromboelastometry-based coagulation management in cardiac surgery: a meta-analysis of 8332 patients. 2018 53(10):2055–8.ĭeppe AC, Weber C, Zimmermann J, Kuhn EW, Slottosch I, Liakopoulos OJ, Choi YH, Wahlers T. Continuous hemoglobin monitoring in pediatric trauma patients with solid organ injury. Welker E, Novak J, Jelsma L, Koehler T, Davis A, DeCou J, Durkin E. Primary care diagnostic technology update: point-of-care testing for glycosylated haemoglobin. Pluddemann A, Price CP, Thompson M, Wolstenholme J, Heneghan C. Point-of-Care diagnostics: recent developments in a connected age. Nayak S, Blumenfeld NR, Laksanasopin T, Sia SK. Transcutaneous monitoring as a replacement for arterial PCO(2) monitoring during nocturnal non-invasive ventilation. Storre JH, Magnet FS, Dreher M, Windisch W. Continuous intra-arterial blood gas monitoring. History of echocardiography and its future applications in medicine. Krishnamoorthy VK, Sengupta PP, Gentile F, Khandheria BK. Point-of-care ultrasound: a trend in health care. However in the main there would be reduced likelihood of major clinical detriment.īuerger AM, Clark KR. On the other hand, there is no doubt that unnecessary procedure deferral is also undesirable, with adverse economic impacts and potential negative effects on patient well-being especially if urgent procedures are incorrectly postponed. As Dr Sarraf and colleagues point out, clinicians performing surgery and other invasive procedures would not be comfortable with 95% sensitivity in detecting an unacceptable coagulopathy pre-procedure, since there would still be a 5% chance of preventable bleeding with all the associated morbidity and mortality connotations. For a clinician the dominant risk and major focus in the example given would be that of performing an invasive procedure on a coagulopathic patient. They emphasize that clinician intolerance of risk is critical to the selection of thresholds, which define the breadth of the grey area and have consequent economic impact. Finally they refer to potential regulatory barriers to the marketing of POC devices for this purpose.įor one of the devices the investigators found that only 9% of the population POC-tested at 99.5% sensitivity for a ‘true’ INR ≥ 1.5 would require formal laboratory testing. ‘True’ INR cut-offs of 1.5 and 1.8 are modelled, first with the whole population and then with skewed datasets created by depleting higher or lower INR sub-groups. They also provide a simulation of two POC devices screening 9320 real day of surgery ‘true’ INR values via published algorithms derived from parallel testing. Apart from a review of the statistical principles involved, the authors detail how to perform an economic analysis of POC screening versus universal laboratory testing, emphasizing that all factors such as user training should be included. For example, the authors describe the lower POC threshold as the ‘sensitivity -threshold’ for a clinically unsafe true INR, whereas we have described it above as a specificity threshold for a safe laboratory INR. This seemingly intuitive approach is explored in much more detail by Dr Sarraf and colleagues, although with some difference in terminology.
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