title: Performance of point-of-care diagnostics for glucose, lactate, and hemoglobin in the management of severe malaria in a resource-constrained hospital in Uganda.
abstract: Severe malaria is frequently managed without access to laboratory testing. We report on the performance of point-of-care tests used to guide the management of a cohort of 179 children with severe malaria in a resource-limited Ugandan hospital. Correlation coefficients between paired measurements for glucose (i-STAT and One Touch Ultra), lactate (i-STAT and Lactate Scout), and hemoglobin (Hb; laboratory and i-STAT) were 0.86, 0.85, and 0.73, respectively. The OneTouch Ultra glucometer readings deviated systematically from the i-STAT values by +1.7 mmol/L. Lactate Scout values were systematically higher than i-STAT by +0.86 mmol/L. Lactate measurements from either device predicted subsequent mortality. Hb estimation by the i-STAT instrument was unbiased, with upper and lower limits of agreement of -34 and +34 g/L, and it was 91% sensitive and 89% specific for the diagnosis of severe anemia (Hb < 50 g/L). New commercially available bedside diagnostic tools, although imperfect, may expedite clinical decision-making in the management of critically ill children in resource-constrained settings.
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine and Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Paediatrics and Child Health, Mulago Hospital and Makerere University, Kampala, Uganda; Department of Paediatrics, Jinja Regional Referral Hospital, Jinja, Uganda; Department of Medicine, University of Washington, Seattle, Washington; Division of Global Pediatrics, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; Sandra A. Rotman Laboratories, Sandra Rotman Centre for Global Health, Toronto, Ontario, Canada; Tropical Disease Unit, University Health Network-Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Hawkes
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Conroy
authors.forename: Robert O
authors.initials: RO
authors.lastname: Opoka
authors.forename: Sophie
authors.initials: S
authors.lastname: Namasopo
authors.forename: W Conrad
authors.initials: WC
authors.lastname: Liles
authors.forename: Chandy C
authors.initials: CC
authors.lastname: John
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Kain
mesh_terms: D000740:Anemia / Q000150:complications / Q000175:diagnosis*; D001786:Blood Glucose / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006295:Health Resources; D006441:Hemoglobin A / Q000032:analysis*; D006761:Hospitals; D006801:Humans; D007003:Hypoglycemia / Q000150:complications / Q000175:diagnosis*; D007223:Infant; D019344:Lactic Acid / Q000097:blood*; D008288:Malaria / Q000097:blood* / Q000150:complications; D008297:Male; D019095:Point-of-Care Systems / Q000592:standards*; D012680:Sensitivity and Specificity; D014454:Uganda
chemical_list: D001786:Blood Glucose; D019344:Lactic Acid; D006441:Hemoglobin A