Comparison of Glucose Point-of-Care Values With Laboratory Values in Critically Ill Patients

Shearer, Anna; Boehmer, Marilyn; Closs, Melanie; Rosa, Rosalina Dela; Hamilton, Jean; Horton, Karen M.; McGrath, Rose; Schulman, Christine S.

doi:10.4037/ajcc2009448

Cited by 34 publications

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“…Preanalytic factors, such as hypoxia, anemia, interfering substances, and specimen type, have been shown to affect the accuracy of POCG measurements. [1][2][3][4][5] There is limited information, however, about the reliability of POCG measurements in the critical high and low ranges. That knowledge is important because accurate testing and prompt reporting of critical values is an important patient safety goal.…”

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confidence: 99%

Reliability of Point-of-Care Capillary Blood Glucose Measurements in the Critical Value Range

Schifman

Nguyen

Page

2014

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Point-of-care glucose (POCG) testing on capillary blood specimens is central to maintaining glycemic control in patients with diabetes. Although there are known performance issues with POCG methods, especially for maintaining tight glucose control, there is little information about the accuracy of results in the critical ranges that may involve life-threatening conditions.Objectives.-To evaluate the reliability of POCG measurements in critical, high (.600 mg/dL) and low (,40 mg/dL) ranges.Design.-One-year retrospective analysis of POCG (ACCU-CHEK glucose meter, Roche Diagnostics Corporation, Indianapolis, Indiana) results for routine patient care were obtained. The frequency and accuracy of repeat testing after critical POCG results was analyzed. A convenience sample of noncritical capillary POCG measurements retested on venous blood specimens by another point-of-care device (RAPIDPoint 405 analyzer, Siemens Medical Solutions USA, Malvern, Pennsylvania) was also evaluated.Results.-Critical values were observed in 2.4 per 1000 POCG tests (256 of 105,928; 0.24%), with the highest rate (76 of 2289; 3.32%) from the emergency department. Twice as many critical high values as critical low values were seen. Nearly 80% of critical POCG tests (204 of 256) were repeated within 10 minutes. Of these 204 repeat measurements, 112 (54.9%) met accuracy criteria (615 mg/dL of low and 620% of high initial values). Accuracy was significantly higher when retesting was performed on the same meter or by the same operator (P .05).Comparison of capillary and venous POCG testing of noncritical results showed no significant difference (P ¼ .95), with 89.8% (125 of 139) meeting accuracy criteria.Conclusions.-POCG measurements in the critical range are frequently erroneous, which is likely caused by preanalytic factors associated with sampling capillary blood. POCG testing practices should include retesting to confirm critical results.(Arch Pathol Lab Med. 2014;138:962-966; doi: 10.5858/ arpa.2013-0455-OA) P oint-of-care glucose (POCG) testing on capillary blood specimens is performed for maintaining glycemic control and for detecting acute hypoglycemic and hyperglycemic conditions. Preanalytic factors, such as hypoxia, anemia, interfering substances, and specimen type, have been shown to affect the accuracy of POCG measurements. [1][2][3][4][5] There is limited information, however, about the reliability of POCG measurements in the critical high and low ranges. That knowledge is important because accurate testing and prompt reporting of critical values is an important patient safety goal. 6A previous study 7 has shown that POCG measurements in critical high and low ranges were frequently erroneous when reevaluated by measuring another capillary or venous blood specimen. However, there is little other information about optimal POCG test performance or practices for accurately detecting critical results. For example, retesting is generally not necessary for checking the accuracy of critical values obtained from clinical laboratory ...

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confidence: 99%

Reliability of Point-of-Care Capillary Blood Glucose Measurements in the Critical Value Range

Schifman

Nguyen

Page

2014

Archives of Pathology &Amp; Laboratory Medicine

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“…The confidence limits were also wide in both groups, more so for the hypotensive group (147.2 mg/dL vs 344.5 mg/dL). After excluding outlying values, the confidence limits became narrower but still spanned across zero, consistent with most method-comparison studies revie wed. 13,[17][18][19]23,29 For studies with separate analysis on hypotensive subgroups, those on vasopressor support also had wider confidence limits compared to normotensive patients. 23,29 This lack of a consistent directional bias precluded us from proposing a safe "correction factor" for capillary glucose values in either group on which to make adjusted intervention thresholds.…”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14][16][17][18][19][21][22][23] For concordance with ISO 2003 criteria, the POC glucose meter used met the minimum accuracy criteria for the normotensive group (95.6% of all values). This was not attained for the hypotensive group, with an overall concordance of only 79.8%.…”

Section: Discussionmentioning

confidence: 99%

“…Peripheral vasoconstriction 538608D STXXX10.1177/1932296814538608Journal of Diabetes Science and TechnologyGaringarao et al research-article2014 in hypoperfusion states leads to increased glucose extraction by tissues due to low capillary flow, resulting in falsely decreased glucose measurements with capillary blood. 12,13 Some studies on critically ill patients include only a small number of measurements taken from patients in shock, resulting in a heterogeneous cohort, [14][15][16][17][18][19][20][21][22] or did not perform analysis on compliance with international accuracy standards. 18,21,23 For those that performed a separate analysis on hypotensive patients, limitations include a small sample size, 12,16 relatively old glucose meter technology, 12 and lack of a reference standard of glucose measurement for comparison of POC glucose meter readings.…”

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Accuracy of Point-of-Care Blood Glucose Measurements in Critically Ill Patients in Shock

Garingarao

Buenaluz-Sedurante

Jimeno

2014

J Diabetes Sci Technol

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Background: A widely used method in monitoring glycemic status of ICU patients is point-of-care (POC) monitoring devices. A possible limitation to this method is altered peripheral blood flow in patients in shock, which may result in over/ underestimations of their true glycemic status. Methods:This study aims to determine the accuracy of blood glucose measurements with a POC meter compared to laboratory methods in critically ill patients in shock. POC blood glucose was measured with a glucose-1-dehydrogenasebased reflectometric meter. The reference method was venous plasma glucose measured by a clinical chemistry analyzer (glucose oxidase-based). Outcomes assessed were concordance to ISO 15197:2003 minimum accuracy criteria for glucose meters, bias in glucose measurements obtained by the 2 methods using Bland-Altman analysis, and clinical accuracy through modified error grid analysis.Results: A total of 186 paired glucose measurements were obtained. ISO 2003 accuracy criteria were met in 95.7% and 79.8% of POC glucose values in the normotensive and hypotensive group, respectively. Mean bias for the normotensive group was -12.4 mg/dL, while mean bias in the hypotensive group was -34.9 mg/dL. POC glucose measurements within the target zone for clinical accuracy were 90.2% and 79.8% for the normotensive and hypotensive group, respectively. Conclusions: POC blood glucose measurements were significantly less accurate in the hypotensive subgroup of ICU patients compared to the normotensive group. We recommend a lower threshold in confirming POC blood glucose with a central laboratory method if clinically incompatible. In light of recently updated accuracy standards, we also recommend alternative methods of glucose monitoring for the ICU population as a whole regardless of blood pressure status.

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“…Recent studies report a statistically significant difference between glucose values obtained by a point-ofcare device and values obtained by a laboratory, with 1 study revealing 20% of values differing by Ͼ20 mg/dL. 39,40 Finally, adverse-event rates were calculated on the basis of data collected Future efforts would benefit from increased granularity of documentation of patient characteristics (eg, underlying diagnosis, gestational age) as well as specifying the need for increased phlebotomy, increased intravenous access, and hyperglycemia after a dextrose infusion.…”

Section: Figurementioning

confidence: 98%

Recognizing Hypoglycemia in Children Through Automated Adverse-Event Detection

Dickerman,

Jacobs,

Vinodrao

et al. 2011

Pediatrics

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Comparison of Glucose Point-of-Care Values With Laboratory Values in Critically Ill Patients

Cited by 34 publications

References 35 publications

Reliability of Point-of-Care Capillary Blood Glucose Measurements in the Critical Value Range

Reliability of Point-of-Care Capillary Blood Glucose Measurements in the Critical Value Range

Accuracy of Point-of-Care Blood Glucose Measurements in Critically Ill Patients in Shock

Recognizing Hypoglycemia in Children Through Automated Adverse-Event Detection

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