title: Comparability of Point-of-Care versus Central Laboratory Hemoglobin Determination in Emergency Patients at a Supra-Maximal Care Hospital.
abstract: Fulfilling the requirements of point-of-care testing (POCT) training regarding proper execution of measurements and compliance with internal and external quality control specifications is a great challenge. Our aim was to compare the values of the highly critical parameter hemoglobin (Hb) determined with POCT devices and central laboratory analyzer in the highly vulnerable setting of an emergency department in a supra maximal care hospital to assess the quality of POCT performance. In 2548 patients, Hb measurements using POCT devices (POCT-Hb) were compared with Hb measurements performed at the central laboratory (Hb-ZL). Additionally, sub collectives (WHO anemia classification, patients with Hb <8 g/dl and suprageriatric patients (age >85y.) were analyzed. Overall, the correlation between POCT-Hb and Hb-ZL was highly significant (r = 0.96, p<0.001). Mean difference was -0.44g/dl. POCT-Hb values tended to be higher than Hb-ZL values (t(2547) = 36.1, p<0.001). Standard deviation of the differences was 0.62 g/dl. Only in 26 patients (1%), absolute differences >2.5g/dl occurred. McNemar´s test revealed significant differences regarding anemia diagnosis according to WHO definition for male, female and total patients (♂ p<0.001; ♀ p<0.001, total p<0.001). Hb-ZL resulted significantly more often in anemia diagnosis. In samples with Hb<8g/dl, McNemar´s test yielded no significant difference (p = 0.169). In suprageriatric patients, McNemar´s test revealed significant differences regarding anemia diagnosis according to WHO definition in male, female and total patients (♂ p<0.01; ♀ p = 0.002, total p<0.001). The difference between Hb-ZL and POCT-Hb with Hb<8g/dl was not statistically significant (<8g/dl, p = 1.000). Overall, we found a highly significant correlation between the analyzed hemoglobin concentration measurement methods, i.e. POCT devices and at the central laboratory. The results confirm the successful implementation of the presented POCT concept. Nevertheless some limitations could be identified in anemic patients stressing the importance of carefully examining clinically implausible results.
authors.affiliation: Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Sigmund- Freud- Str. 25, 53127 Bonn, Germany.
authors.forename: Ramona C
authors.initials: RC
authors.lastname: Dolscheid-Pommerich
authors.affiliation: Department of Rehabilitation and Special Education, University of Cologne, Herbert-Lewin-Str. 10, 50931 Köln, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dolscheid
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund- Freud- Str. 25, 53127 Bonn, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Grigutsch
authors.affiliation: Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Sigmund- Freud- Str. 25, 53127 Bonn, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Stoffel-Wagner
authors.affiliation: Emergency Department, University Hospital Bonn, Sigmund- Freud- Str. 25, 53127 Bonn, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Graeff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000175:diagnosis; D002648:Child; D004632:Emergency Medical Services; D005260:Female; D006403:Hematologic Tests / Q000295:instrumentation / Q000379:methods*; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007755:Laboratories, Hospital; D008297:Male; D008875:Middle Aged; D000067716:Point-of-Care Testing; D011933:Reagent Kits, Diagnostic; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D006454:Hemoglobins; D011933:Reagent Kits, Diagnostic