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Blanchard IE, Kozicky R, Dalgarno D, Simms J, Goulder S, Williamson TS, Biesbroek S, Page L, Leaman K, Snozyk S, Redman L, Spackman K, Doig CJ, Lang ES, Lazarenko G. Community paramedic point of care testing: validity and usability of two commercially available devices. BMC Emerg Med 2019; 19:30. [PMID: 31046680 PMCID: PMC6498549 DOI: 10.1186/s12873-019-0243-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 04/10/2019] [Indexed: 11/21/2022] Open
Abstract
Background Community Paramedics (CPs) require access to timely blood analysis in the field to guide treatment and transport decisions. Point of care testing (POCT), as opposed to laboratory analysis, may offer a solution, but limited research exists on CP POCT. The purpose of this study was to compare the validity of two devices (Abbott i-STAT® and Alere epoc®) by CPs in the community. Methods In a CP programme responding to 6000 annual patient care events, a split sample validation of POCT against traditional laboratory analysis for seven analytes (sodium, potassium, chloride, creatinine, hemoglobin, hematocrit, and glucose) was conducted on a consecutive sample of patients. The difference of proportion of discrepant results between POCT and laboratory was compared using a two sample proportion test. Usability was analysed by survey of CP experience, a linear mixed effects model of Systems Usability Scale (SUS) adjusted for CP clinical and POCT experience, an expert heuristic evaluation of devices, a review of device-logged errors, and coded observations of POCT use during quality control testing. Results Of 1649 episodes of care screened for enrollment, 174 required a blood draw, with 108 episodes (62.1%) enrolled from 73 participants. Participants had a mean age of 58.7 years (SD16.3); 49% were female. In 4 of 646 (0.6%) comparisons, POCT reported a critical value but the laboratory did not; with no statistically significant (p = 0.323) difference between i-STAT® (0.9%;95%CI:0.0,1.9%) compared with epoc® (0.3%;95%CI:0.0,0.9%). There were no instances of the laboratory reporting a critical value when POCT did not. In 88 of 1046 (8.4%) comparisons the a priori defined acceptable difference between POCT and the laboratory was exceeded; occurring more often in epoc® (10.7%;95%CI:8.1,13.3%) compared with i-STAT® (6.1%;95%CI:4.1,8.2%)(p = 0.007). Eighteen of 19 CP surveys were returned, with 11/18 (61.1%) preferring i-STAT® over epoc®. The i-STAT® had a higher mean SUS score (higher usability) compared with epoc® (84.0/100 vs. 59.6/100; p = 0.011). There were no statistically significant differences in device logged errors between i-STAT® and epoc® (p = 0.063). Conclusions CP programmes can expect clinically valid results from POCT. Device usability assessments should be considered with any local implementation as the two POCT systems have different strengths. Electronic supplementary material The online version of this article (10.1186/s12873-019-0243-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ian E Blanchard
- Alberta Health Services, Emergency Medical Services, 10101 Southport Road SW, Calgary, AB, T2W 3N1, Canada. .,University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada.
| | - Ryan Kozicky
- Alberta Health Services, Emergency Medical Services, 10101 Southport Road SW, Calgary, AB, T2W 3N1, Canada
| | - Dana Dalgarno
- Alberta Health Services, Emergency Medical Services, 10101 Southport Road SW, Calgary, AB, T2W 3N1, Canada
| | - Justin Simms
- University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Stacy Goulder
- Alberta Health Services, Emergency Medical Services, 10101 Southport Road SW, Calgary, AB, T2W 3N1, Canada
| | - Tyler S Williamson
- University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Susan Biesbroek
- Alberta Health Services, Human Factors, Calgary, Alberta, Canada
| | - Lenore Page
- Alberta Health Services, Human Factors, Calgary, Alberta, Canada
| | - Karen Leaman
- Calgary Laboratory Services, Calgary, Alberta, Canada
| | | | - Lyle Redman
- Calgary Laboratory Services, Calgary, Alberta, Canada
| | - Keith Spackman
- Alberta Health Services, Emergency Medical Services, 10101 Southport Road SW, Calgary, AB, T2W 3N1, Canada
| | - Christopher J Doig
- University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Eddy S Lang
- University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Gerald Lazarenko
- Alberta Health Services, Emergency Medical Services, 10101 Southport Road SW, Calgary, AB, T2W 3N1, Canada
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Cembrowski G, Lyon ME, Klonoff DC. Glucose data-mining study inconclusive. Can J Diabetes 2015; 39:354-5. [PMID: 26028478 DOI: 10.1016/j.jcjd.2015.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 03/13/2015] [Indexed: 10/23/2022]
Affiliation(s)
- George Cembrowski
- Alberta Health Services, Walter C. MacKenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Martha E Lyon
- Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - David C Klonoff
- Diabetes Research Institute, Mills-Peninsula Health Services, San Mateo, California, USA
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