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Accuracy of bedside glucometry in critically ill children with peripheral hypoperfusion

Anant Khositseth1, Onsuthi Pharadornuwat, Rojjanee Lertbunrian

  • 1Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand, anant.kho@mahidol.ac.th.

Journal of Clinical Monitoring and Computing
|May 8, 2014
PubMed

Insights

Glucose test strips in critically ill children require careful interpretation. Whole blood glucose (WBG) from arterial samples offers greater accuracy than capillary blood glucose (CBG), especially with low perfusion index.

Area of Science:

  • Pediatric Critical Care
  • Clinical Chemistry
  • Medical Device Accuracy

Background:

  • The reliability of glucose test strips for critically ill children is uncertain.
  • Accurate glucose monitoring is vital for managing critically ill pediatric patients.

Purpose of the Study:

  • To evaluate the accuracy of glucose test strips using capillary blood glucose (CBG) and whole blood glucose (WBG) in critically ill children.
  • To assess the impact of hemodynamic parameters, specifically perfusion index (PI), on glucose test strip accuracy.

Main Methods:

  • Compared glucose test strip results (CBG and WBG) against laboratory plasma blood glucose (PBG) in 181 pediatric intensive care unit patients (1 month to 18 years).
  • Assessed accuracy based on ISO 15197 and Clarke Error Grid (CEG) criteria.
  • Analyzed the influence of perfusion index (PI ≤ 0.3) on accuracy using Bland-Altman plots.

Main Results:

  • Whole blood glucose (WBG) from arterial samples showed higher accuracy (98.3% and 95.2%) compared to capillary blood glucose (CBG) (88.7% and 83.3%) against PBG (ISO 15197:2003 and 2013).
  • WBG from venous samples also demonstrated better accuracy (92.2% and 87.0%) than CBG (79.7% and 72.9%).
  • Low perfusion index (PI ≤ 0.3) was associated with significantly poorer CBG strip accuracy (bias and precision of 30.2±23.4 mg/dL vs. 7.4±17.7 mg/dL in acceptable PI group).

Conclusions:

  • Capillary blood glucose (CBG) test strips should be used with caution in critically ill children.
  • Low perfusion index significantly impairs the accuracy of CBG test strips.
  • Whole blood glucose (WBG) monitoring from arterial samples is recommended for glucose management in pediatric patients with peripheral hypoperfusion.

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