Point-of-care prothrombin time testing in paediatric intensive care: an observational study of the ease of use of two devices
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Published on: October 12, 2012
Natalie Urwyler1, Eveline Staub, Lukas P Staub
1Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA. urwyler@stanford.edu
Insights
Point-of-care prothrombin time testing in pediatric intensive care offers advantages. The CoaguChek XS Plus demonstrated good agreement with lab standards, unlike CoaLine, making it suitable for pediatric use.
Area of Science:
- Clinical Chemistry
- Pediatric Critical Care Medicine
- Point-of-Care Testing
Background:
- Pediatric blood sampling faces challenges with venous access and sample volume.
- Accurate prothrombin time (PT) monitoring is crucial in pediatric intensive care units (ICUs).
Purpose of the Study:
- To evaluate the clinical utility of two point-of-care (POC) PT testing devices in pediatric ICU patients.
- To assess the ease of use and correlation of POC PT results with standard laboratory measurements.
Main Methods:
- A single-center observational study was conducted in a tertiary center's pediatric ICU.
- Thirty-eight pediatric patients (0-13 years) were included to assess the CoaguChek XS Plus and CoaLine devices.
- Ease of use and agreement between POC and laboratory PT measurements were evaluated.
Main Results:
- CoaguChek XS Plus had a 2% failure rate, CoaLine 17%, and the lab standard 4%.
- CoaguChek XS Plus showed better ease of use ratings by personnel.
- CoaguChek XS Plus demonstrated good agreement (r=0.79) and CoaLine moderate agreement (r=0.72) with laboratory PT standards, despite observed variability.
Conclusions:
- CoaguChek XS Plus offers good agreement for PT testing in pediatric ICUs.
- POC PT testing in pediatrics provides rapid results and reduces blood volume requirements.
- CoaguChek XS Plus is a valuable tool for PT monitoring in pediatric critical care settings.
Background:
Two major difficulties arise when taking blood samples in children: the challenge of venous access and the comparatively large amount of blood required.
Objective:
To assess the value of point-of-care prothrombin time testing in paediatric intensive care patients. We evaluated two point-of-care devices, CoaguChek XS Plus and CoaLine, assessing ease of use in clinical practice and correlation with the standard prothrombin time measurement of the haematology laboratory.
Design:
Single-centre observational study.
Setting:
Between October 2007 and March 2008, patients in an interdisciplinary paediatric ICU of a tertiary centre were analysed.
Patients Or Other Participants:
Thirty-eight patients, 22 female and 16 male (58 and 42%), aged between 0 and 13 years, participated in the study. The intention was to evaluate the ease of use of the devices in daily clinical practice, and no exclusion criteria were applied.
Main Outcome Measures:
The usefulness of the two point-of-care devices in the paediatric setting was evaluated. Measurements of point-of-care and standard laboratory prothrombin time were compared in terms of agreement and correlation.
Results:
CoaguChek XS Plus had a failure rate of 2%, CoaLine 17% and the laboratory standard 4%. CoaguChek XS Plus received a better ease of use rating than CoaLine by the study personnel. Compared with the laboratory standard, there was considerable variability of the observed measurements with both devices. The measurements of CoaguChek XS Plus and the standard had a correlation coefficient r of being 0.79. CoaLine and the standard had a correlation coefficient r value of 0.72.
Conclusion:
CoaguChek XS Plus showed 'good' agreement, whereas CoaLine showed 'moderate' agreement compared with prothrombin time values using the standard method. The fast availability of results and the reduction of the required blood volume are advantages of point-of-care tests in the paediatric setting.
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