Value of point-of-care blood testing in emergent trauma management.
BACKGROUND
No prospective study demonstrates the value of point-of-care laboratory testing (POCT) in the management of major trauma.


METHODS
In a prospective, noninterventional, study of 200 major trauma patients, we evaluated the influence of a blood POCT profile (hemoglobin, Na+, K+, Cl-, blood urea nitrogen, glucose, pH, PCO2, PO2, HCO3-, base deficit, and lactate) on emergent diagnostic and therapeutic interventions. Physicians responded to a standardized set of questions on their diagnostic and therapeutic plans before and after the availability of POCT results. Management plan changes were deemed emergently appropriate, if they were influenced by the POCT results and, within the ensuing 30 minutes, the change in management was likely to reduce morbidity or conserve resources.


RESULTS
For emergently appropriate plan changes, Na+, Cl-, K+, and blood urea nitrogen were never influential, whereas in each of 6.0% of cases (95% confidence interval [CI], 3.5%-10.2%) at least one of the remaining POCT parameters was influential. An emergently appropriate change was based on hemoglobin in 3.5% of cases (95% CI, 1.0%-6.1%), blood gas parameters in 3.0% of cases (95% CI, 0.64%-5.7%), lactate in 2.5% of cases (95% CI, 1.1%-5.7%), and glucose in 0.5% of cases (95% CI, 0.1%-2.8%). All of these cases involved blunt injury.


CONCLUSIONS
Na+, Cl-, K+, and blood urea nitrogen levels do not influence the initial management of major trauma patients. In patients with severe blunt injury, hemoglobin, glucose, blood gas, and lactate measurements occasionally result in morbidity-reducing or resource-conserving management changes.
Asimos
A W
AW
Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina 28232-2861, USA.
Gibbs
M A
MA
Marx
J A
JA
Jacobs
D G
DG
Erwin
R J
RJ
Norton
H J
HJ
Thomason
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques; D016208:Databases, Factual; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D007755:Laboratories, Hospital; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D019095:Point-of-Care Systems; D011446:Prospective Studies; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000097:blood* / Q000145:classification / Q000175:diagnosis; D014950:Wounds, Penetrating / Q000097:blood* / Q000145:classification / Q000175:diagnosis