Accuracy of Handheld Point-of-Care Fingertip Lactate Measurement in the Emergency Department

Abstract

Introduction: Early recognition of elevated lactate levels in sepsis may hasten the detection of those patients eligible for aggressive resuscitation. Point-of-care (POC) testing is now increasingly available for use in the emergency department (ED). We examined the accuracy and time-saving effect of a handheld POC device for the measurement of fingertip and whole blood lactate as compared with reference laboratory testing in critically ill ED patients.Methods: A convenience sample of adult ED patients receiving serum lactate testing was prospectively enrolled at an urban, tertiary care US hospital. Consenting patients underwent fingertip POC lactate measurement with a portable device and simultaneous whole blood sampling for analysis by both the POC device and standard laboratory analyzer (“reference method”). Lactate measurements were compared by intraclass correlation (ICC) and Bland and Altman plots. Differences in time to test result were compared by paired t test.Results: Twenty-four patients, 19 (79%) with sepsis and 21 (88%) with lactate levels below 4 mmol/L, were included from April 2005 to May 2005. Fingertip POC and whole blood POC lactate measurements each correlated tightly with the reference method (ICC = 0.90 and ICC = 0.92, respectively). Mean time between obtaining fingertip lactate samples and whole blood reference lactate samples was 8 ± 13 minutes. Mean time between obtaining POC and reference laboratory lactate results was 65 minutes (95% confidence interval, 30–103).Conclusion: Fingertip POC lactate measurement is an accurate method to determine lactate levels in infected ED patients with normal or modestly elevated lactate values and significantly decreases time to test results. These findings should be verified in a larger, more critically ill, ED population.

Performance of Point-of-Care Diagnostics for Glucose, Lactate, and Hemoglobin in the Management of Severe Malaria in a Resource-Constrained Hospital in Uganda

“…The test performance characteristics in these contexts have been well-described. [3][4][5][6][7][8][9][10][11][12][13] Hypoglycemia and anemia are common complications of malaria that require laboratory diagnosis, because clinical assessment is an unsatisfactory substitute. Furthermore, lactate level at admission is an important prognostic indicator in severe malaria.…”

Validating a point of care lactate meter in adult patients with sepsis presenting to the emergency department of a tertiary care hospital of a low- to middle-income country

“…This Vol 8, No 3, 2017 study is in concordance with previously available data/ studies that handheld POC lactate devices may serve as an effective alternative method of evaluation of blood lactate levels. [10,[20][21][22][23][24] A study conducted by Singer et al [24] showed that not only was there a reduction in time to administration of intravenous fl uids and antibiotics with a handheld/bedside POC device for lactate measurement, but there was also a reduction in the overall admissions to intensive care units and mortality.…”

“…[9] Early recognition of elevated lactate levels in sepsis may hasten identification of patients eligible for aggressive resuscitation. [10] There are numerous hindrances to the early detection of lactate levels in the ED due to prolonged ED waiting time, increased patient volume and delays due to limitations of traditional laboratory analysis [11] Test results may therefore take hours to return and must be actively sought out by the clinician. The gold standard for the determination of lactate is the laboratory goldstandard enzymatic colorimetric assay method.…”

Integrative research agenda for diagnosis in sepsis

“…Investigations are on-going for biochip immunoassay platforms for biomarkers such as CRP and PCT (12). Blood lactate levels are another nonspecific sepsis marker and research suggests that a POC lactate device may highlight patients at risk of sepsis and requiring resuscitation (13,14).…”