Point-of-care testing in Paediatric settings in the UK and Ireland: a cross-sectional study

Abstract

Background Point-of-care testing (POCT) is diagnostic testing performed at or near to the site of the patient. Understanding the current capacity, and scope, of POCT in this setting is essential in order to respond to new research evidence which may lead to wide implementation. Methods A cross-sectional online survey study of POCT use was conducted between 6th January and 2nd February 2020 on behalf of two United Kingdom (UK) and Ireland-based paediatric research networks (Paediatric Emergency Research UK and Ireland, and General and Adolescent Paediatric Research UK and Ireland). Results In total 91/109 (83.5%) sites responded, with some respondents providing details for multiple units on their site based on network membership (139 units in total). The most commonly performed POCT were blood sugar (137/139; 98.6%), urinalysis (134/139; 96.4%) and blood gas analysis (132/139; 95%). The use of POCT for Influenza/Respiratory Syncytial Virus (RSV) (45/139; 32.4%, 41/139; 29.5%), C-Reactive Protein (CRP) (13/139; 9.4%), Procalcitonin (PCT) (2/139; 1.4%) and Group A Streptococcus (5/139; 3.6%) and was relatively low. Obstacles to the introduction of new POCT included resources and infrastructure to support test performance and quality assurance. Conclusion This survey demonstrates significant consensus in POCT practice in the UK and Ireland but highlights specific inequity in newer biomarkers, some which do not have support from national guidance. A clear strategy to overcome the key obstacles of funding, evidence base, and standardising variation will be essential if there is a drive toward increasing implementation of POCT.

Point-of-care diagnostic technology in paediatric ambulatory care: a qualitative interview study of English clinicians and stakeholders

“…Our finding of unmet needs corroborated one systematic meta-analysis which demonstrated that very few studies, limited to a handful of diseases, have shown benefit of POC tests in paediatric populations 5. Concerns over lack of funding were similarly found in a survey of UK children’s emergency departments and paediatric assessment units 18. In keeping with the concerns expressed in that survey about quality assurance, our participants stated that they wanted tests with high specificity and sensitivity.…”

“… 5 Concerns over lack of funding were similarly found in a survey of UK children’s emergency departments and paediatric assessment units. 18 In keeping with the concerns expressed in that survey about quality assurance, our participants stated that they wanted tests with high specificity and sensitivity. In contrast to that survey, our participants did not express concern that there was lack of evidence surrounding the use of POC tests.…”

“…Other recent studies have highlighted obstacles to greater use of POC tests in children. Pandey et al , in a survey of UK children’s emergency departments and paediatric assessment units, found lack of funding, a lack of evidence and governance issues surrounding quality assurance of tests, meant several new biomarkers, which already exist, had not been adopted in the majority of units 18. Rasti et al , in a qualitative survey of nurses and doctors in a Swedish children’s emergency department, found that while POC tests benefits included better satisfaction from families who wanted a test for their child and greater reassurance in some instances in clinical decision-making, those surveyed feared the use of POC tests in hospital and at home might drive more unnecessary testing and that reliance on POC tests could diminish clinical skills 19…”

Red Code Management in a Pediatric Emergency Department: A Retrospective Study

“…In the ED setting, clinicians need to make accurate and timely decisions regarding emergency management, and POC tests have the potential to provide rapid and accurate results [9,14]. In our analysis, blood counts and multiparametric blood gas analysis were largely performed, and they provided a great part of pathologic results, confirming the utility of their execution.…”

“…Alongside the PALS algorithm, international guidelines and local hospital protocols aim to standardize care and optimize outcomes [10][11][12][13]. Diagnostic assessments for detecting and identifying severe clinical conditions include bedside, laboratory, and instrumental tests [9,14].…”