Clinical chemistry
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Comparative Study
Impact of point-of-care testing on patients' length of stay in a large emergency department.
We prospectively investigated whether routine use of a point-of-care testing (POCT) device by nonlaboratory operators in the emergency department (ED) for all patients requiring the available tests could shorten patient length of stay (LOS) in the ED. ED patient LOS, defined as the length of time between triage (initial patient interview) and discharge (released to home or admitted to hospital), was examined during a 5-week experimental period in which ED personnel used a hand-held POCT device to perform Na, K, Cl, glucose (Gluc), and blood urea nitrogen (BUN) testing. Preliminary data demonstrated acceptable accuracy of the hand-held device. ⋯ Median LOS during the experimental period was 209 min vs 201 min for the combined control periods. Stratifying patients by presenting condition (chest pain, trauma, etc.), discharge/admit status, or presence/absence of other central laboratory tests did not reveal a decrease in patient LOS for any patient subgroup during the experimental period. From these observations, we consider it unlikely that routine use of a hand-held POCT device in a large ED such as ours is sufficient by itself to impact ED patient LOS.
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Comparative Study
VIDAS D-dimer: fast quantitative ELISA for measuring D-dimer in plasma.
VIDAS D-dimer (bioMérieux) is a new quantitative ELISA for D-dimer determination designed for the VIDAS automated system. The test contains single-dose, ready-to-use reagents and is completed within 35 min. Quantitative results are obtained from a calibration curve stored in the software of the system and expressed as fibrinogen equivalent units. ⋯ Reproducibility (CV) within and between runs ranges from 5% to 7%. There is no interference from heparin, bilirubin, hemoglobin, fibrinogen degradation products, or plasma turbidity. Comparison with a conventional ELISA (y) gave good correlation (r= 0.91, n= 579) and comparable results (y= 1.35x - 148, S(y/x)= 750), especially for D-dimer concentrations ranging from 0 to 1000 micrograms/L (y= 1.09x - 10.6, r= 0.88, S(y/x)= 170).
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Letter Comparative Study
Serum troponin T: diagnostic marker for acute myocarditis.
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We evaluated a novel, portable breath sampler/CO-quantifying instrument [Baby's Breath Carbon Monoxide Analyzer (BB); Natus Medical], developed for use at the bedside or with gas samples collected into bags. Bench tests demonstrated that the CO measurements were linear, accurate, and precise when compared with gas chromatography (GC) results. In vivo tests (n = 30) performed with adults showed excellent correlation between end-tidal breath CO measurements (ETCO) corrected for inhaled CO (ETCOc) as determined by BB and GC. ⋯ The imprecision, assessed by the mean of the population's CV for triplicate determinations, was 11%. Measurements with healthy and hemolytic term newborns showed that ETCOc values of > 3 microL/L correlated with known hemolytic conditions. We conclude that this instrument is clinically reliable and can be used to noninvasively measure ETCO in neonates and adults.
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Because of the potential for methemoglobinemia during nitric oxide therapy in newborns, methods are needed to accurately quantify methemoglobin (MetHb) in the presence of the high concentrations of fetal hemoglobin (Hb F), bilirubin, and lipids seen in these patients. Spectral differences between fetal and adult Hbs invalidate assumptions of conventional multiwavelength Hb photometry, so we evaluated an "overdetermined" system (Ciba-Corning Model 270), in which absorbances at seven wavelengths are measured to quantify four Hb derivatives. Adult and umbilical cord blood (Hb F 96%) samples were prepared to contain known MetHb fractions. ⋯ No significant differences were seen for adult and cord blood samples with identical MetHb fractions (P = 0.72), whereas a significant difference was noted with an exactly determined system (P = 0.0033). At clinically relevant MetHb fractions (< 15%), a trend towards increased values in cord blood was noted with an exactly determined system (y = 1.0520x + 0.7600). We conclude that this overdetermined system measures MetHb accurately in samples from patients with large concentrations of Hb F.