Comparison of the accuracy of hemoglobin point of care testing using HemoCue and GEM Premier 3000 with automated hematology analyzer in emergency room.
The laboratory analysis provides accurate, but time consuming hemoglobin level estimation especially in the emergency setting. The reliability of time-sparing point of care devices (POCT) remains uncertain. We tested two POCT devices accuracy (HemoCue®201+and Gem®Premier™3000) in routine emergency department workflow. Blood samples taken from patients admitted to the emergency department were analyzed for hemoglobin concentration using a laboratory reference Beckman Coulter LH 750 (HBLAB), the HemoCue (HBHC) and the Gem Premier 3000 (HBGEM). Pairwise comparison for each device and HbLABwas performed using correlation and the Bland-Altman methods. The reliability of transfusion decision was assessed using three-zone error grid. A total of 292 measurements were performed in 99 patients. Mean hemoglobin level were 115 ± 33, 110 ± 28 and 111 ± 30 g/l for HbHC, HbGEMand HbLABrespectively. A significant correlation was observed for both devices: HbHCversus HbLAB(r2= 0.93, p < 0.001) and HBGEMversus HBLAB(r2= 0.86, p < 0.001). The Bland-Altman method revealed bias of -3.7 g/l (limits of agreement -20.9 to 13.5) for HBHCand HBLABand 2.5 g/l (-18.6 to 23.5) for HBGEMand HBLAB, which significantly differed between POCT devices (p < 0.001). Using the error grid methodology: 94 or 91 % of values (HbHCand HbGEM) fell in the zone of acceptable difference (A), whereas 0 and 1 % (HbHCand HbGEM) were unacceptable (zone C). The absolute accuracy of tested POCT devices was low though reaching a high level of correlation with laboratory measurement. The results of the Morey´s error grid were unfavorable for both POCT devices.
Department of Anesthesiology and Intensive Care, The Faculty of Medicine, The University Hospital, Plzen - Charles University Prague, alej Svobody 80, 304 60, Plzeň, Czech Republic. zatloukalj@fnplzen.cz.
Jan
J
Zatloukal
Department of Anesthesiology and Intensive Care, The Faculty of Medicine, The University Hospital, Plzen - Charles University Prague, alej Svobody 80, 304 60, Plzeň, Czech Republic.
Jiri
J
Pouska
Department of Anesthesiology and Intensive Care, The Faculty of Medicine, The University Hospital, Plzen - Charles University Prague, alej Svobody 80, 304 60, Plzeň, Czech Republic.
Jakub
J
Kletecka
Department of Anesthesiology and Intensive Care, The Faculty of Medicine, The University Hospital, Plzen - Charles University Prague, alej Svobody 80, 304 60, Plzeň, Czech Republic.
Richard
R
Pradl
Department of Anesthesiology and Intensive Care, The Faculty of Medicine, The University Hospital, Plzen - Charles University Prague, alej Svobody 80, 304 60, Plzeň, Czech Republic.
Jan
J
Benes
D000328:Adult; D000368:Aged; D001331:Automation; D001803:Blood Transfusion; D004635:Emergency Medicine / Q000295:instrumentation* / Q000379:methods; D004636:Emergency Service, Hospital; D005260:Female; D006405:Hematology / Q000295:instrumentation / Q000379:methods*; D006452:Hemoglobinometry / Q000295:instrumentation* / Q000379:methods; D006454:Hemoglobins / Q000032:analysis / Q000737:chemistry; D006470:Hemorrhage / Q000175:diagnosis / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D000067716:Point-of-Care Testing; D011446:Prospective Studies; D015203:Reproducibility of Results
D006454:Hemoglobins
Blood transfusion; Emergency medicine; Hemoglobin; Hemoglobinometry; Hemorrhage; Point of care systems