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Tintu AN, Buño Soto A, Van Hoof V, Bench S, Malpass A, Schilling UM, Rooney K, Oliver Sáez P, Relker L, Luppa P. The influence of undetected hemolysis on POCT potassium results in the emergency department. Clin Chem Lab Med 2024; 0:cclm-2024-0202. [PMID: 38726766 DOI: 10.1515/cclm-2024-0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/26/2024] [Indexed: 05/15/2024]
Abstract
OBJECTIVES This study aimed to evaluate discrepancies in potassium measurements between point-of-care testing (POCT) and central laboratory (CL) methods, focusing on the impact of hemolysis on these measurements and its impact in the clinical practice in the emergency department (ED). METHODS A retrospective analysis was conducted using data from three European university hospitals: Technische Universitat Munchen (Germany), Hospital Universitario La Paz (Spain), and Erasmus University Medical Center (The Netherlands). The study compared POCT potassium measurements in EDs with CL measurements. Data normalization was performed in categories for potassium levels (kalemia) and hemolysis. The severity of discrepancies between POCT and CL potassium measurements was assessed using the reference change value (RCV). RESULTS The study identified significant discrepancies in potassium between POCT and CL methods. In comparing POCT normo- and mild hypokalemia against CL results, differences of -4.20 % and +4.88 % were noted respectively. The largest variance in the CL was a +4.14 % difference in the mild hyperkalemia category. Additionally, the RCV was calculated to quantify the severity of discrepancies between paired potassium measurements from POCT and CL methods. The overall hemolysis characteristics, as defined by the hemolysis gradient, showed considerable variation between the testing sites, significantly affecting the reliability of potassium measurements in POCT. CONCLUSIONS The study highlighted the challenges in achieving consistent potassium measurement results between POCT and CL methods, particularly in the presence of hemolysis. It emphasised the need for integrated hemolysis detection systems in future blood gas analysis devices to minimise discrepancies and ensure accurate POCT results.
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Affiliation(s)
- Andrei N Tintu
- Department of Clinical Chemistry Rotterdam, Erasmus Medical Center, Zuid-Holland, Netherlands
| | - Antonio Buño Soto
- Clinical Pathology, 16268 Hospital Universitario La Paz , Madrid, Spain
| | - Viviane Van Hoof
- Faculty of Medicine and Health Sciences, 26660 University of Antwerp , Wilrijk, Belgium
| | | | - Anthony Malpass
- IDS, Formerly of Becton and Dickinson UK Ltd, Wokingham, Berkshire, UK
| | | | | | - Paloma Oliver Sáez
- Laboratory Medicine, 16268 La Paz - Cantoblanco - Carlos III University Hospital , Madrid, Spain
| | - Lasse Relker
- Institute for Clinical Chemistry and Pathobiochemistry, 9184 Eberhard Karls Universitat Tubingen , Tubingen, Germany
| | - Peter Luppa
- Institut für Klinische Chemie, 9184 Klinikum rechts der Isar der Technischen Universitat Munchen , Munchen, Germany
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Çubukçu HC, Topcu Dİ, Yenice S. Machine learning-based clinical decision support using laboratory data. Clin Chem Lab Med 2024; 62:793-823. [PMID: 38015744 DOI: 10.1515/cclm-2023-1037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/17/2023] [Indexed: 11/30/2023]
Abstract
Artificial intelligence (AI) and machine learning (ML) are becoming vital in laboratory medicine and the broader context of healthcare. In this review article, we summarized the development of ML models and how they contribute to clinical laboratory workflow and improve patient outcomes. The process of ML model development involves data collection, data cleansing, feature engineering, model development, and optimization. These models, once finalized, are subjected to thorough performance assessments and validations. Recently, due to the complexity inherent in model development, automated ML tools were also introduced to streamline the process, enabling non-experts to create models. Clinical Decision Support Systems (CDSS) use ML techniques on large datasets to aid healthcare professionals in test result interpretation. They are revolutionizing laboratory medicine, enabling labs to work more efficiently with less human supervision across pre-analytical, analytical, and post-analytical phases. Despite contributions of the ML tools at all analytical phases, their integration presents challenges like potential model uncertainties, black-box algorithms, and deskilling of professionals. Additionally, acquiring diverse datasets is hard, and models' complexity can limit clinical use. In conclusion, ML-based CDSS in healthcare can greatly enhance clinical decision-making. However, successful adoption demands collaboration among professionals and stakeholders, utilizing hybrid intelligence, external validation, and performance assessments.
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Affiliation(s)
- Hikmet Can Çubukçu
- General Directorate of Health Services, Rare Diseases Department, Turkish Ministry of Health, Ankara, Türkiye
- Hacettepe University Institute of Informatics, Ankara, Türkiye
| | - Deniz İlhan Topcu
- Health Sciences University İzmir Tepecik Education and Research Hospital, Medical Biochemistry, İzmir, Türkiye
| | - Sedef Yenice
- Florence Nightingale Hospital, Istanbul, Türkiye
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Bunch DR, Durant TJ, Rudolf JW. Artificial Intelligence Applications in Clinical Chemistry. Clin Lab Med 2023; 43:47-69. [PMID: 36764808 DOI: 10.1016/j.cll.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Artificial intelligence (AI) applications are an area of active investigation in clinical chemistry. Numerous publications have demonstrated the promise of AI across all phases of testing including preanalytic, analytic, and postanalytic phases; this includes novel methods for detecting common specimen collection errors, predicting laboratory results and diagnoses, and enhancing autoverification workflows. Although AI applications pose several ethical and operational challenges, these technologies are expected to transform the practice of the clinical chemistry laboratory in the near future.
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Affiliation(s)
- Dustin R Bunch
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, 700 Children's Drive, C1923, Columbus, OH 43205-2644, USA; Department of Pathology, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Thomas Js Durant
- Department of Laboratory Medicine, Yale School of Medicine, 55 Park Street, Room PS 502A, New Haven, CT 06510, USA
| | - Joseph W Rudolf
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT 84112, USA; ARUP Laboratories, 500 Chipeta Way, MC 115, Salt Lake City, UT 84108, USA.
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Spies NC, Farnsworth CW, Jackups R. Data-Driven Anomaly Detection in Laboratory Medicine: Past, Present, and Future. J Appl Lab Med 2023; 8:162-179. [PMID: 36610428 DOI: 10.1093/jalm/jfac114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/25/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Anomaly detection is an integral component of operating a clinical laboratory. It covers both the recognition of laboratory errors and the rapid reporting of clinically impactful results. Procedures for identifying laboratory errors and highlighting critical results can be improved by applying modern data-driven approaches. CONTENT This review will prepare the reader to appraise anomaly detection literature, identify common sources of anomalous results in the clinical laboratory, and offer potential solutions for common shortcomings in current laboratory practices. SUMMARY Laboratories should implement data-driven approaches to detect technical anomalies and keep them from entering the medical record, while also using the full array of clinical metadata available in the laboratory information system for context-dependent, patient-centered result interpretations.
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Affiliation(s)
- Nicholas C Spies
- Washington University Department of Pathology and Immunology, St. Louis, MO
| | | | - Ronald Jackups
- Washington University Department of Pathology and Immunology, St. Louis, MO
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Buño A, Oliver P. POCT errors can lead to false potassium results. ADVANCES IN LABORATORY MEDICINE 2022; 3:142-152. [PMID: 37361872 PMCID: PMC10197277 DOI: 10.1515/almed-2021-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/04/2021] [Indexed: 06/28/2023]
Abstract
Point-of-care-testing (POCT) facilitates rapid availability of results that allows prompt clinical decision making. These results must be reliable and the whole process must not compromise its quality. Blood gas analyzers are one of the most used methods for POCT tests in Emergency Departments (ED) and in critical patients. Whole blood is the preferred sample, and we must be aware that hemolysis can occur. These devices cannot detect the presence of hemolysis in the sample, and because of the characteristics of the sample, we cannot visually detect it either. Hemolysis can alter the result of different parameters, including potassium with abnormal high results or masking low levels (hypokalemia) when reporting normal concentrations. Severe hyperkalemia is associated with the risk of potentially fatal cardiac arrhythmia and demands emergency clinical intervention. Hemolysis can be considered the most frequent cause of pseudohyperkalemia (spurious hyperkalemia) or pseudonormokalemia and can be accompanied by a wrong diagnosis and an ensuing inappropriate clinical decision making. A complete review of the potential causes of falsely elevated potassium concentrations in blood is presented in this article. POCT programs properly led and organized by the clinical laboratory can help to prevent errors and their impact on patient care.
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Affiliation(s)
- Antonio Buño
- Clinical Laboratory Department, Hospital Universitario La Paz, Madrid, Spain
| | - Paloma Oliver
- Clinical Laboratory Department, Hospital Universitario La Paz, Madrid, Spain
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Rajsic S, Breitkopf R, Bachler M, Treml B. Diagnostic Modalities in Critical Care: Point-of-Care Approach. Diagnostics (Basel) 2021; 11:diagnostics11122202. [PMID: 34943438 PMCID: PMC8700511 DOI: 10.3390/diagnostics11122202] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 02/07/2023] Open
Abstract
The concept of intensive care units (ICU) has existed for almost 70 years, with outstanding development progress in the last decades. Multidisciplinary care of critically ill patients has become an integral part of every modern health care system, ensuing improved care and reduced mortality. Early recognition of severe medical and surgical illnesses, advanced prehospital care and organized immediate care in trauma centres led to a rise of ICU patients. Due to the underlying disease and its need for complex mechanical support for monitoring and treatment, it is often necessary to facilitate bed-side diagnostics. Immediate diagnostics are essential for a successful treatment of life threatening conditions, early recognition of complications and good quality of care. Management of ICU patients is incomprehensible without continuous and sophisticated monitoring, bedside ultrasonography, diverse radiologic diagnostics, blood gas analysis, coagulation and blood management, laboratory and other point-of-care (POC) diagnostic modalities. Moreover, in the time of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, particular attention is given to the POC diagnostic techniques due to additional concerns related to the risk of infection transmission, patient and healthcare workers safety and potential adverse events due to patient relocation. This review summarizes the most actual information on possible diagnostic modalities in critical care, with a special focus on the importance of point-of-care approach in the laboratory monitoring and imaging procedures.
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Affiliation(s)
- Sasa Rajsic
- General and Surgical Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, Medical University Innsbruck, 6020 Innsbruck, Austria; (S.R.); (M.B.)
| | - Robert Breitkopf
- Transplant Surgical Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, Medical University Innsbruck, 6020 Innsbruck, Austria;
| | - Mirjam Bachler
- General and Surgical Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, Medical University Innsbruck, 6020 Innsbruck, Austria; (S.R.); (M.B.)
| | - Benedikt Treml
- General and Surgical Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, Medical University Innsbruck, 6020 Innsbruck, Austria; (S.R.); (M.B.)
- Correspondence:
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Punchoo R, Bhoora S, Pillay N. Applications of machine learning in the chemical pathology laboratory. J Clin Pathol 2021; 74:435-442. [PMID: 34117102 DOI: 10.1136/jclinpath-2021-207393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/16/2021] [Accepted: 03/10/2021] [Indexed: 01/05/2023]
Abstract
Machine learning (ML) is an area of artificial intelligence that provides computer programmes with the capacity to autodidact and learn new skills from experience, without continued human programming. ML algorithms can analyse large data sets quickly and accurately, by supervised and unsupervised learning techniques, to provide classification and prediction value outputs. The application of ML to chemical pathology can potentially enhance efficiency at all phases of the laboratory's total testing process. Our review will broadly discuss the theoretical foundation of ML in laboratory medicine. Furthermore, we will explore the current applications of ML to diverse chemical pathology laboratory processes, for example, clinical decision support, error detection in the preanalytical phase, and ML applications in gel-based image analysis and biomarker discovery. ML currently demonstrates exploratory applications in chemical pathology with promising advancements, which have the potential to improve all phases of the chemical pathology total testing pathway.
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Affiliation(s)
- Rivak Punchoo
- Tshwane Academic Division, National Health Laboratory Service, Pretoria, Gauteng, South Africa .,Chemical Pathology, University of Pretoria Faculty of Health Sciences, Pretoria, Gauteng, South Africa
| | - Sachin Bhoora
- Chemical Pathology, University of Pretoria Faculty of Health Sciences, Pretoria, Gauteng, South Africa
| | - Nelishia Pillay
- Computer Science, University of Pretoria Faculty of Engineering Built Environment and IT, Pretoria, Gauteng, South Africa
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