Reliability of point-of-care testing for glucose measurement in critically ill adults*

Kanji, Salmaan; Buffie, Jennifer; Hutton, Brian; Bunting, Peter S.; Singh, Avinder; McDonald, Kevin B; Fergusson, Dean; McIntyre, Lauralyn; Hébert, Paul C.

doi:10.1097/01.ccm.0000189939.10881.60

Cited by 369 publications

(299 citation statements)

References 13 publications

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“…Similar to Kanji et al 7 and Lacara et al, 8 we found that finger edema did not help explain differences between POC and laboratory glucose values (P = .54). Several reasons may account for the lack of difference with study 8 did researchers seek to determine if the 2 POC blood sources (catheter, fingerstick) yielded equivalent blood glucose levels.…”

Section: Poc Vs Laboratory Glucose Valuessupporting

confidence: 77%

“…Confounding factors identified in earlier studies include pH, shocklike states, hypoxemia, hematocrit level, vasopressor use, and peripheral edema. 5,7,9,10,19,20,22,[28][29][30][31][32][33][34] Hoping to use the results of our study to affect the way POC testing is done in our unit, we selected 2 of these variables to evaluate, because POC testing finger edema: the limited number of high scores for edema in our study (<25% of patients had scores of 3+ or 4+), poor interrater reliability in scoring of edema, and a lack of effect of edema on POC and laboratory differences.…”

Section: Effect Of Hematocrit and Peripheral Edemamentioning

confidence: 99%

“…[4][5][6][7][8]10,[19][20][21][22][23][24][25][26][27] In most of those studies, however, POC glucose testing was done with fingerstick blood; blood was obtained from an existing catheter device (arterial catheters) and appropriate statistical analysis was done in only 2 studies. 7,8 Our study extends the findings of significant differences between POC and laboratory glucose analysis to CVC blood.…”

Section: Poc Vs Laboratory Glucose Valuesmentioning

confidence: 99%

“…Although POC devices for glucose testing are calibrated for use with capillary fingerstick blood, clinicians often obtain blood for POC testing from indwelling arterial or central venous catheters (CVCs). Despite the frequency of this practice, few clinical studies [4][5][6][7][8][9][10] have been done to evaluate the performance of POC glucose devices with blood from indwelling catheters. Several of the studies had serious methodological problems, including small sample size, 4 poorly described methods, 5,9,10 and inappropriate statistical analysis.…”

Section: Instrumentsmentioning

confidence: 99%

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Differences in Glucose Values Obtained From Point-of-Care Glucose Meters and Laboratory Analysis in Critically Ill Patients

Cook

Laughlin

Moore

et al. 2009

American Journal of Critical Care

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Background Blood for glucose analysis is often obtained interchangeably from indwelling catheters and fingersticks. Objectives To determine the level of agreement between glucose values obtained by laboratory analysis and with a pointof-care device for blood from 2 different sources: fingerstick and a central venous catheter. Methods A method-comparison design was used. Point-of-care values for blood from fingersticks and catheters were compared with laboratory values for blood from catheters in a convenience sample of 67 critically ill patients. The effects of hematocrit level and finger edema on differences in glucose values between the 2 methods were also evaluated. A t test was used to determine differences in glucose values obtained via the 2 methods. Differences and limits of agreement were also calculated. Results Laboratory glucose values for blood from a catheter differed significantly from point-of-care values for blood from the catheter (t 1,66 = -9.18; P < .001) and from a fingerstick (t 1,66 = 6.53; P < .001). Glucose values for the 2 methods differed by 20 mg/dL or more for 1 of 6 patients (15%) for catheter samples and for 1 of 5 (21%) for fingerstick samples. Point-of-care glucose values for fingerstick and catheter samples did not differ (P = .98). Hematocrit level significantly explained the difference in glucose values between the 2 methods for both catheter (R 2 = 0.288; P < .001) and fingerstick (R 2 = 0.280; P = .02) samples. Conclusions Notice to CE enrollees:A closed-book, multiple-choice examination following this article tests your under standing of the following objectives: 1. Describe the relationship of euglycemic glucose levels to outcomes for critically ill patients. 2. Understand the importance of differences between point-of-care (POC) glucose testing and laboratory glucose testing used with critically ill patients. 3. Recognize the relationship between hemoglobin levels and the accuracy of POC test values for blood glucose.

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Section: Poc Vs Laboratory Glucose Valuessupporting

confidence: 77%

Section: Effect Of Hematocrit and Peripheral Edemamentioning

confidence: 99%

Section: Poc Vs Laboratory Glucose Valuesmentioning

confidence: 99%

Section: Instrumentsmentioning

confidence: 99%

See 2 more Smart Citations

Differences in Glucose Values Obtained From Point-of-Care Glucose Meters and Laboratory Analysis in Critically Ill Patients

Cook

Laughlin

Moore

et al. 2009

American Journal of Critical Care

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“…Direct comparison between the laboratory and a blood gas analyser with both in the laboratory is required. Arterial samples have been shown to be more reliable; venous blood may be contaminated by glucose infusions, producing a different concentration throughout the sample, and capillary samples may be affected by poor perfusion [4,18].…”

Section: Discussionmentioning

confidence: 99%

Uncertainties in the measurement of blood glucose in paediatric intensive care: implications for clinical trials of tight glycaemic control

et al. 2011

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Purpose: In preparation for a tight glycaemic control (TGC) clinical trial we assessed the agreement between methods used to measure blood glucose in critically ill children. Methods: Service evaluation comparing blood gas and main laboratory analysers with point-ofcare (POC) devices PCX, ACCUChek and Hemocue. Results: Two hundred forty-five samples from 157 children measured on 2-4 devices provided 790 values. Marked variation was evident in glucose values between devices, time between tests, sample (whole blood/plasma) and source; 39% of paired values had [20% difference. The decision to start insulin at 7 mmol/L differed depending on the device used for 33% of samples. At low glucose values (\4 mmol/L), differences up to 1.8 mmol/L were evident. The blood gas analyser read lower than all POC models and the laboratory analyser (less risk of undetected hypoglycaemia). An inverse relationship was evident between haematocrit (Hct) and glucose error using POC devices.PCX values for samples with Hct \30% were higher (85%), whereas those for Hct values [38% were lower (66%). Glycolysis occurred during transfer of samples to the laboratory. Using the PCX at the bedside resulted in 0.5 mmol/L mean difference higher than laboratory values; locating the PCX in the laboratory reduced this to 0.2 mmol/L. Conclusions: Discrepancies between measurements may mask hypoglycaemia, and the potential benefits of controlling hyperglycaemia may not be achieved. Variation introduced by different devices, sample or source may have led to misclassification of treatment decisions contributing to the conflicting results of TGC studies.

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Tight Glycemic Control in Critically Ill Adults

Finfer

Delaney

2008

JAMA

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Reliability of point-of-care testing for glucose measurement in critically ill adults*

Abstract: The magnitude of the differences in the glucose values offered by the four different methods of glucose measurement led to frequent clinical disagreements regarding insulin dose titration in the context of an insulin infusion protocol for aggressive glucose control.

Cited by 369 publications

References 13 publications

Differences in Glucose Values Obtained From Point-of-Care Glucose Meters and Laboratory Analysis in Critically Ill Patients

Differences in Glucose Values Obtained From Point-of-Care Glucose Meters and Laboratory Analysis in Critically Ill Patients

Uncertainties in the measurement of blood glucose in paediatric intensive care: implications for clinical trials of tight glycaemic control

Tight Glycemic Control in Critically Ill Adults

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