title: Point of care coagulometry in prehospital emergency care: an observational study.
abstract: BACKGROUND
  Haemostatic impairment can have a crucial impact on the outcome of emergency patients, especially in cases of concomitant antithrombotic drug treatment. In this prospective observational study we used a point of care (POC) coagulometer in a prehospital physician-based emergency medical system in order to test its validity and potential value in the treatment of emergency patients.
  
  
  METHODS
  During a study period of 12 months, patients could be included if venous access was mandatory for further treatment. The POC device CoaguChek® was used to assess international normalized ratio (INR) after ambulance arrival at the scene. Results were compared with in-hospital central laboratory assessment of INR. The gain of time was analysed as well as the potential value of POC testing through a questionnaire completed by the responsible prehospital emergency physician.
  
  
  RESULTS
  A total of 103 patients were included in this study. POC INR results were highly correlated with results of conventional assessment of INR (Bland-Altman-bias: 0.014). Using a cutoff value of INR >1.3, the device's sensitivity to detect coagulopathy was 100 % with a specificity of 98.7 %. The median gain of time was 69 min. Treating emergency physicians considered the value of prehospital POC INR testing 'high' in 9 % and 'medium' in 21 % of all patients. In patients with tracer diagnosis 'neurology', the value of prehospital INR assessment was considered 'high' or 'medium' (63 %) significantly more often than in patients with non-neurological tracer diagnoses (24 %).
  
  
  CONCLUSIONS
  Assessment of INR through a POC coagulometer is feasible in prehospital emergency care and provides valuable information on haemostatic parameters in patients. Questionnaire results suggest that POC INR testing may present a valuable technique in selected patients. Whether this information translates into an improved management of respective patients has to be evaluated in further studies.
authors.affiliation: Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. christopher.beynon@med.uni-heidelberg.de.
authors.forename: Christopher
authors.initials: C
authors.lastname: Beynon
authors.affiliation: Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. a.erk@stud.uni-heidelberg.de.|Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. a.erk@stud.uni-heidelberg.de.
authors.forename: Angelina G
authors.initials: AG
authors.lastname: Erk
authors.affiliation: Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. anna.potzy@med.uni-heidelberg.de.
authors.forename: Anna
authors.initials: A
authors.lastname: Potzy
authors.affiliation: Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. stefan.mohr@med.uni-heidelberg.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Mohr
authors.affiliation: Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. erik.popp@med.uni-heidelberg.de.
authors.forename: Erik
authors.initials: E
authors.lastname: Popp
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage; D001778:Blood Coagulation Disorders / Q000175:diagnosis* / Q000188:drug therapy; D001780:Blood Coagulation Tests / Q000295:instrumentation*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005858:Germany; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems / Q000458:organization & administration*; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity
chemical_list: D000925:Anticoagulants