Substituting Whole Blood for Urine in a Bedside Pregnancy Test

Fromm, Christian; Likourezos, Antonios; Haines, Lawrence; Khan, Abu N.G.A.; Williams, Janet; Berezow, Joel

doi:10.1016/j.jemermed.2011.05.028

Cited by 15 publications

(17 citation statements)

References 5 publications

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“…This case generates the question of appropriate pregnancy testing in a woman with low likelihood of pregnancy but with significant risk factors for a highly morbid pregnancy. While the sensitivity for urine pregnancy testing nears 100% for normally implanted pregnancies, [24][25][26] especially after 4 to 6 weeks of gestation, there still exists a small possibility for false-negative results. Quantitative serum pregnancy testing may have correctly identified this patient as pregnant, despite the negative qualitative urine test, and cost and time differences between the two tests are negligible.…”

Section: Discussionmentioning

confidence: 99%

Placenta Percreta and Incomplete Uterine Rupture after Endometrial Ablation and Tubal Occlusion

Kohn

Popek

Diaz-Arrastia

et al. 2016

AJP Rep

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Endometrial ablation offers symptomatic relief for menorrhagia. Pregnancy after ablation is rare but is often complicated due to pregnancy loss, growth restriction, preterm premature rupture of membranes, preterm delivery, and morbidly adherent placentation, a dangerous complication that can result in hemorrhage, intensive care unit admission, and cesarean hysterectomy. We report a case of pregnancy conceived contemporaneously with endometrial ablation and tubal occlusion. Diagnosis of pregnancy was delayed due to low suspicion. Complications included cervical implantation and placenta percreta, necessitating hysterectomy with the fetus in situ. Intraoperatively, incomplete uterine rupture was noted. Abnormal neovascularization, fibrous adhesions, and anatomical distortion necessitated a complex surgical approach. Women undergoing endometrial ablation must be thoroughly counseled about the serious risks of postablation pregnancy, the need for contraception, and the risk of sterilization failure. Pregnancy should remain in the differential diagnosis for women of reproductive age, regardless of tubal occlusion. Cases of placenta percreta should be referred early to centers of excellence with multidisciplinary teams.

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Section: Discussionmentioning

confidence: 99%

Placenta Percreta and Incomplete Uterine Rupture after Endometrial Ablation and Tubal Occlusion

Kohn

Popek

Diaz-Arrastia

et al. 2016

AJP Rep

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“…The decision to wait 10 minutes was based upon the prior accuracy study protocol from Fromm et. 2 After 10 minutes, the time and result were recorded in a study binder. The blood results were not used clinically in any manner.…”

Section: Methodsmentioning

confidence: 99%

“…Fromm et al previously demonstrated in 633 patients that urine and whole blood have similar test characteristics when used in one common brand of POC pregnancy testing, with a higher sensitivity and a lower human chorionic gonadotropin (hCG) threshold level observed in the whole blood specimen group. 2 …”

Section: Introductionmentioning

confidence: 99%

Comparison of Result Times Between Urine and Whole Blood Point-of-care Pregnancy Testing

Gottlieb

Wnek

Moskoff

et al. 2016

WestJEM

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IntroductionPoint-of-care (POC) pregnancy testing is commonly performed in the emergency department (ED). One prior study demonstrated equivalent accuracy between urine and whole blood for one common brand of POC pregnancy testing. Our study sought to determine the difference in result times when comparing whole blood versus urine for the same brand of POC pregnancy testing.MethodsWe conducted a prospective, observational study at an urban, academic, tertiary care hospital comparing the turnaround time between order and result for urine and whole blood pregnancy tests collected according to standard protocol without intervention from the investigators. After the blood was collected, the nurse would place three drops onto a Beckman Coulter ICON 25 Rapid HCG bedside pregnancy test and set a timer for 10 minutes. At the end of the 10 minutes, the result and time were recorded on an encoded data sheet and not used clinically. The same make and model analyzer was also used for urine tests in the lab located within the ED. The primary outcome was the difference in mean turnaround time between whole blood in the ED and urine testing in the adjacent lab results. Concordance between samples was assessed as a secondary outcome.Results265 total patients were included in the study. The use of whole blood resulted in a mean time savings of 21 minutes (95% CI 16–25 minutes) when compared with urine (p<0.001). There was 99.6% concordance between results, with one false negative urine specimen with a quantitative HCG level of 81 mIU/L.ConclusionOur results suggest that the use of whole blood in place of urine for bedside pregnancy testing may reduce the total result turnaround time without significant changes in accuracy in this single-center study.

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“…Even under circumstances that sought to minimize sample transit times, POCT results were available an average of 46 minutes earlier than from the central laboratory [ 15 ]. Several studies evaluating point-of-care pregnancy testing in the ED found that, regardless of whether ED staff evaluated pregnancy status by using urine or a qualitative human chorionic gonadotropin immunoassay kit, POCT could yield sufficiently sensitive results faster than if samples were sent to a central laboratory [ 11 ] as processing and handling delays inherently extended laboratory TATs.…”

Section: Reviewmentioning

confidence: 99%

Point-of-care testing in the overcrowded emergency department – can it make a difference?

Rooney

Schilling

2014

Crit Care

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Emergency departments (EDs) face several challenges in maintaining consistent quality care in the face of steadily increasing public demand. Improvements in the survival rate of critically ill patients in the ED are directly related to the advancement of early recognition and treatment. Frequent episodes of overcrowding and prolonged waiting times force EDs to operate beyond their capacity and threaten to impact upon patient care. The objectives of this review are as follows: (a) to establish overcrowding as a threat to patient outcomes, person-centered care, and public safety in the ED; (b) to describe scenarios in which point-of-care testing (POCT) has been found to ameliorate factors thought to contribute to overcrowding; and (c) to discuss how POCT can be used directly, and indirectly, to expedite patient care and improve outcomes. Various studies have shown that overcrowding in the ED has profound effects on operational efficiency and patient care. Several reports have quantified overcrowding in the ED and have described a relationship between heightened periods of overcrowding and delays in treatment, increased incidence of adverse events, and an even greater probability of mortality. In certain scenarios, POCT has been found to increase the number of patients discharged in a timely manner, expedite triage of urgent but non-emergency patients, and decrease delays to treatment initiation. This review concludes that POCT, when used effectively, may alleviate the negative impacts of overcrowding on the safety, effectiveness, and person-centeredness of care in the ED.

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Substituting Whole Blood for Urine in a Bedside Pregnancy Test

Cited by 15 publications

References 5 publications

Placenta Percreta and Incomplete Uterine Rupture after Endometrial Ablation and Tubal Occlusion

Placenta Percreta and Incomplete Uterine Rupture after Endometrial Ablation and Tubal Occlusion

Comparison of Result Times Between Urine and Whole Blood Point-of-care Pregnancy Testing

Point-of-care testing in the overcrowded emergency department – can it make a difference?

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