title: Point-of-care testing for coagulation studies in a stroke protocol: a time-saving innovation.
abstract: OBJECTIVE
  Time counts in thrombolytic therapy for stroke. An international normalized ratio (INR) greater than 1.7 may preclude its use. We studied whether the use of point-of-care testing (POCT) for INR in the emergency department (ED) may substitute for the same test done in the central hospital laboratory, thereby reducing time to treatment.
  
  
  METHODS
  We performed a prospective observational study comparing a POCT analysis of INR (i-STAT-1; Abbott Inc, Abbott Park, Ill) with a simultaneously drawn sample sent to the central laboratory. We tested a convenience sample of adult patients taking warfarin who presented to the ED of a tertiary teaching hospital.
  
  
  RESULTS
  Thirty-two patients were enrolled. A receiver operator curve analysis was performed. Sensitivity and specificity were calculated for laboratory INR cutoff of 1.7. The area under the curve was 0.979 (95% confidence interval [CI], 0.843-0.991). When POCT INR was 2.1, the sensitivity for laboratory INR being higher than 1.7 was 100% (CI, 62.9%-100.0%), and the specificity was 90.5 (CI, 69.6-98.5). When POCT INR was 1.8, the specificity for laboratory INR being lower than 1.7 was 100% (CI, 83.7%-100%), and the sensitivity was 62.5% (CI, 24.7%-91.0%). The regression coefficient (r) value was 0.9648.
  
  
  CONCLUSIONS
  Correlation of POCT INR with that of the central laboratory and receiver operator curve characteristics are excellent. In general, POCT INR is about 0.3 higher than the laboratory INR. This is not generally of clinical importance, but when using cutoff of 1.7 (central laboratory), it may be. We describe a 3-tiered system for use of POCT INR in determining use of tissue-type plasminogen activator.
authors.affiliation: Hartford Hospital, University of Connecticut, 06102, USA. mdresch@harthosp.org
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Drescher
authors.forename: Andrea
authors.initials: A
authors.lastname: Spence
authors.forename: Darryl
authors.initials: D
authors.lastname: Rockwell
authors.forename: Ilene
authors.initials: I
authors.lastname: Staff
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Smally
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019411:Clinical Laboratory Techniques; D016001:Confidence Intervals; D004636:Emergency Service, Hospital; D006801:Humans; D019934:International Normalized Ratio / Q000379:methods*; D016014:Linear Models; D008875:Middle Aged; D019095:Point-of-Care Systems; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D020521:Stroke / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014859:Warfarin / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D014859:Warfarin; D010959:Tissue Plasminogen Activator