Clin Chem Lab Med
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Severe traumatic brain injury (TBI) is associated with a 30%-70% mortality rate. S100B has been proposed as a biomarker for indicating outcome after TBI. Nevertheless, controversy has arisen concerning the predictive value of S100B for severe TBI in the context of multitrauma. Therefore, our aim was to determine whether S100B serum levels correlate with primary outcome following isolated severe TBI or multitrauma in males. ⋯ Increased serum S100B levels constitute a valid predictor of unfavourable outcome in severe TBI, regardless of the presence of associated multitrauma.
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The glycemia decision limits recommended by WHO/ADA for type 2 diabetes detection are derived from clinical signs in advanced stages of the disease. Since insulin secretion patterns and sensitivitity are impaired at the beginning of type 2 diabetes, this stage may be better suited to identify decision limits with higher diagnostic efficiency than those currently applied. ⋯ The efficiency of type 2 diabetes diagnosis can be improved by optimizing cutoff values according to disease prevalence. Unexpectedly, the optimized 2-h post-load cutoff was lower for capillary blood than for venous plasma. It is proposed to identify a risk group e.g., by characteristics of the metabolic syndrome in which the 2-h post-challenge concentration is determined using lower cut-off values than presently recommended.
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Comparative Study
Influence of the needle bore size used for collecting venous blood samples on routine clinical chemistry testing.
Despite remarkable advances in technology and laboratory automation, results of laboratory testing still suffer from a high degree of preanalytical variability. Although there is no definitive evidence, the use of small-gauge needles for venipuncture is usually discouraged to reduce the chance of producing unsuitable specimens. ⋯ The results of our investigation indicate that 23 G needles, if handled correctly, will not introduce any statistically or clinically significant error to the measurement results compared to a 21 G needle. For the 25 G needle, we observed increased variability for potassium compared to a 23 G needle. Small-bore needles of 25 G or less cannot be universally recommended when collecting venous blood for clinical chemistry testing and should be reserved for selected circumstances, such as in patients with problematical venous accesses and newborns. In such cases, however, the bias introduced by the use of smaller needles should always be taken into consideration when interpreting test results.
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The aim of this study was to identify patients with myocardial necrosis in pre-hospital phase during transport by ambulance, without ST-segment elevation (NSTE) on the ambulance ECG. The analytical performance of the i-STAT troponin I (cTnI) method was assessed. A total of 53 NSTE ambulance ECG patients admitted to hospital were followed. ⋯ The median ambulance turnaround time (TAT) was 12 min and median hospital TAT was 40 min, a difference of 28 min. The high sensitivity of the i-STAT cTnI method integrated with tele-medicine procedures could play an important role in the management of acute coronary syndrome patients related to the pre-hospital phase (early diagnosis and treatment in the ambulance). These approaches may allow improvements in patient outcomes and continuous monitoring of the POCT network in the central laboratory, thus meeting quality requirements.
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In this study the analytical performance of eight glucose point-of-care testing (POCT) devices was evaluated. For this purpose, POCT measurement of glucose in heparinized blood collected from patients was paralleled by determination of the glucose concentration in the respective plasma by an analyzer (Hitachi 917) in the central laboratory, providing traceable results. ⋯ In conclusion, this study shows an insufficient trueness of glucose measurements by POCT devices in the normo- and hypoglycemic range. To improve quality assessment, sample splitting and simultaneous measurement of blood glucose concentration every 4 weeks by POCT devices and of plasma glucose concentration by a reliable TMP is recommended.