Point-of-care prothrombin time testing in paediatric intensive care:  an observational study of the ease of use of two devices.
BACKGROUND
Two major difficulties arise when taking blood samples in children: the challenge of venous access and the comparatively large amount of blood required.


OBJECTIVE
To assess the value of point-of-care prothrombin time testing in paediatric intensive care patients. We evaluated two point-of-care devices, CoaguChek XS Plus and CoaLine, assessing ease of use in clinical practice and correlation with the standard prothrombin time measurement of the haematology laboratory.


METHODS
Single-centre observational study.


METHODS
Between October 2007 and March 2008, patients in an interdisciplinary paediatric ICU of a tertiary centre were analysed.


METHODS
Thirty-eight patients, 22 female and 16 male (58 and 42%), aged between 0 and 13 years, participated in the study. The intention was to evaluate the ease of use of the devices in daily clinical practice, and no exclusion criteria were applied.


METHODS
The usefulness of the two point-of-care devices in the paediatric setting was evaluated. Measurements of point-of-care and standard laboratory prothrombin time were compared in terms of agreement and correlation.


RESULTS
CoaguChek XS Plus had a failure rate of 2%, CoaLine 17% and the laboratory standard 4%. CoaguChek XS Plus received a better ease of use rating than CoaLine by the study personnel. Compared with the laboratory standard, there was considerable variability of the observed measurements with both devices. The measurements of CoaguChek XS Plus and the standard had a correlation coefficient r of being 0.79. CoaLine and the standard had a correlation coefficient r value of 0.72.


CONCLUSIONS
CoaguChek XS Plus showed 'good' agreement, whereas CoaLine showed 'moderate' agreement compared with prothrombin time values using the standard method. The fast availability of results and the reduction of the required blood volume are advantages of point-of-care tests in the paediatric setting.
Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA. urwyler@stanford.edu
Natalie
N
Urwyler
Eveline
E
Staub
Lukas P
LP
Staub
Karin
K
Daetwyler
Simon
S
Fluri
Tanja
T
Sollberger
Lorenz
L
Theiler
Robert
R
Greif
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D019095:Point-of-Care Systems; D011446:Prospective Studies; D011517:Prothrombin Time / Q000295:instrumentation / Q000379:methods*