Point-of-care testing: where is the evidence? A systematic survey

Abstract

Point-of-care testing (POCT) has had rapid techno logical development and their use is widespread in clinical laboratories to assure reduction of turn-aroundtime and rapid patient management in some clinical settings where it is important to make quick decisions. Until now the papers published about the POCT have focused on the reliability of the technology used and their analy tical accuracy. We aim to perform a systematic survey of the evidence of POCT efficacy focused on clinical outcomes, selecting POCT denoted special analytes characterized by possible high clinical impact. We searched in Medline and Embase. Two independent reviewers assessed the eligibility, extracted study details and assessed the methodological quality of studies. We analyzed 84 studies for five POCT instruments: neonatal bilirubin, procalcitonin, intra-operative parathyroid hormone, troponin and blood gas analysis. Studies were at high risk of bias. Most of the papers (50%) were studies of correlation between the results obtained by using POCT instruments and those obtained by using laboratory instruments. These data showed a satisfactory correlation between methods when similar analytical reactions were used. Only 13% of the studies evaluated the impact of POCT on clinical practice. POCT decreases the time elapsed for making decisions on patient management but the clinical outcomes have never been adequately evaluated. Our work shows that, although POCT has the potential to provide beneficial patient outcome, further studies may be required, especially for defining its real utility on clinical decision making.

Comparability of Point-of-Care versus Central Laboratory Hemoglobin Determination in Emergency Patients at a Supra-Maximal Care Hospital

“…With steadily decreasing resources and increasing costs through diagnosis, a scientific confirmation of the benefits of POCT in the decision making process in patient care has not been sufficiently examined to date [12]. Nevertheless, in many central emergency centers, POCT is the first step in the standardized emergency process in combination with a triage system.…”

Clinical, operational and economic outcomes of point-of-care blood gas analysis in COPD patients

“…However, the publications do not assess the consequences of conducting the measurement as POCT because they assume that the same results can lead to similar clinical actions [3,15]. Other studies compare the period when POCT is not available in a unit with the subsequent period in which POCT has been incorporated, but do not compare the differences between conducting them at the POCT or in a clinical laboratory [16].…”

Patient perspectives on test result communication in primary care: a qualitative study

“…30,31 In the future, the increase in affordability and accuracy of point-of-care testing, along with access to patient records via the internet, may have a positive impact on many of the issues highlighted here, including helping to reduce delay. 32 The number of calls to a practice may be reduced considerably by automated, proactive communication of normal results, such as text messages; there is some, albeit limited, evidence that communicating normal results in this way can reduce anxiety in some patients. 33,34 In addition, initiatives such as the UK Department of Health's Power of Information strategy aim to increase electronic access to results and may also reduce the demand on staff time.…”