title: Agreement between laboratory results and on-site pathology testing using Bayer DCA2000+ and Cholestech LDX point-of-care methods in remote Australian Aboriginal communities.
abstract: BACKGROUND
  Indigenous Australians experience high risk of diabetes and cardiovascular disease. On-site pathology data can help identify those at risk. We sought to evaluate point-of-care (POC) analysers in remote Australian communities.
  
  
  METHODS
  Results obtained from population screening (n=76-118) on the DCA2000+ and Cholestech LDX analysers were compared to laboratory measures. Results were compared using parametric and non-parametric statistical analyses, including the use of conventional cut-off values for pathology markers.
  
  
  RESULTS
  Agreements (95% CI) between the two methods for categorising results according to the selected cut-off values ranged from 88% (77-94%) for HDL-C to 99% (92-100%) for glucose, and Kappa coefficients ranged from 0.668 for total cholesterol to 0.945 for glucose. Differences in median values were not clinically meaningful but were statistically significant (P<0.05) for urinary albumin (18.8 [inter-quartile range: 7.5-41.7] vs. 18.0 [5.5-43.2] mg/L), creatinine (12.1 [7.9-17.1] vs. 12.4 [8.1-17.0] mmol/L) and albumin:creatinine ratio (ACR; 1.66 [0.70-3.53] vs. 1.27 [0.46-3.03] mg/mmol), HDL cholesterol (HDL-C; 1.05 [0.95-1.25] vs. 1.00 [0.81-1.20] mmol/L), triglycerides (1.65 [1.12-2.19] vs. 1.49 [1.07-2.36] mmol/L) and glucose (5.2 [4.5-6.0] vs. 5.2 [4.7-5.8] mmol/L), respectively, for POC and laboratory methods. Median HbA1c (5.6% [5.3-6.0%] vs. 5.5% [5.3-6.1%]) and total cholesterol (4.4 [3.8-5.0] vs. 4.4 [3.8-5.1] mmol/L) did not differ significantly. Bland-Altman analyses showed statistically significant (but not clinically meaningful) variation in the measurement difference across analyte concentration for all measures except ACR and total cholesterol.
  
  
  CONCLUSIONS
  POC instruments provided a reliable alternative to conventional laboratory methods for screening for chronic disease risk factors in locations remote from urban centres.
authors.affiliation: The Menzies School of Health Research, John Mathews Building, Royal Darwin Hospital, Rocklands Drive, and Institute of Advanced Studies, Charles Darwin University, Darwin NT, Australia. tomer.shemesh@menzies.edu.au
authors.forename: Tomer
authors.initials: T
authors.lastname: Shemesh
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Rowley
authors.forename: Mark
authors.initials: M
authors.lastname: Shephard
authors.forename: Leonard S
authors.initials: LS
authors.lastname: Piers
authors.forename: Kerin
authors.initials: K
authors.lastname: O'Dea
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000418:Albumins / Q000032:analysis; D008076:Cholesterol, HDL / Q000097:blood*; D003955:Diagnostic Tests, Routine / Q000379:methods* / Q000592:standards*; D004194:Disease; D006331:Heart Diseases / Q000097:blood / Q000473:pathology / Q000652:urine; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D019095:Point-of-Care Systems / Q000592:standards*; D012111:Residence Characteristics; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D000418:Albumins; D008076:Cholesterol, HDL