Analysis of the Cerebrospinal Fluid at Point of Care in Resource-Limited Setting: A Pilot Study

In the face of an emergency, a decision on the need for a timely intervention must be made urgently especially when it has to do with the brain. This study was conducted to determine the usefulness of Urine combistix and glucometer as a "point of care" testing tool in the emergency analysis of cerebrospinal fluid (CSF) in resource-limited settings.

In this pilot cross-sectional study, CSF and blood glucose were simultaneously measured using a point of care glucometer and central laboratory. The CSF protein, glucose, blood and leucocytes were also assessed using the urine combistix strips. The CSF/blood glucose ratios obtained at the bedside with a glucometer versus those obtained by the central laboratory were also compared.

Turn-around time for glucometer and Combistix analysis was 3.5minutes (3-4mins) versus 360minutes (300- 600minutes) for the laboratory. A strong correlation was observed amongst urine Combistix values for CSF protein, blood, leucocyte and glucose with those obtained from the laboratory (ROC of 0.875, sensitivity:75% and specificity: 100%). In addition, there was significant correlation of the CSF-blood glucose ratios from both the laboratory versus glucometer.

This pilot study showed that a combination of Combistix analysis for CSF protein, glucose, blood and leucocyte values plus a glucometer analysis of CSF and blood glucose can serve as a reliable and accurate synergistic means for early diagnosis of CSF abnormalities particularly in patients suspected to have meningitis. Finally, it provides a template on which an accurate CSF diagnostic kit can be developed.