Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, United States.
Clin Chim Acta. 2012 Jan 18;413(1-2):88-92. doi: 10.1016/j.cca.2011.05.006. Epub 2011 May 12.
Measurement of creatinine and calculation of the estimated glomerular filtration rate (eGFR) are widely employed to identify patients with chronic kidney disease who are at risk for contrast induced acute kidney injury and nephrogenic systemic fibrosis. However, patients may present for radiologic studies without a recent creatinine/eGFR necessitating cancelation of the study or performance of the scan without contrast. Both of these approaches are suboptimal.
We implemented a rapid whole blood point-of-care (POCT) creatinine test (iSTAT, Abbott Point-of-Care) in our radiology department and assessed the impact on clinical operations.
Over a 7-month period a total of 3087 creatinine tests were performed. Overall 5.3% of patients presenting for scans (441/month) did not have a recent eGFR. An audit of 1 month of creatinine/eGFR values showed that 74% were normal permitting the scan to be performed without further consideration. Of the abnormal values 74% were performed with contrast and 26% without. Of note 78% of patients with an abnormal eGFR had a normal creatinine value. The cost of the POC test was $10.06 compared to a cost of $5.32 (including phlebotomy) for a creatinine performed in the central laboratory. The added incremental cost for the POC test was therefore $4.74.
Determining the cost effectiveness of the rapid test is extremely challenging because the analysis would need to take many complex factors into consideration including the effect on workflow in the radiology department, the clinical impact of more timely scans, the clinical and financial consequences of performing scans with or without contrast and the impact on revenues complicated by differential reimbursement rates and payor mix. However, given the benefits of the test on radiology operations and on the quality and timeliness of care it appears that the POCT test is cost effective and improves clinical operations.
测量肌酐并计算估算肾小球滤过率（eGFR）被广泛用于识别患有慢性肾病的患者，这些患者有发生对比剂诱导的急性肾损伤和肾源性系统性纤维化的风险。然而，患者可能会在没有最近的肌酐/eGFR 的情况下接受放射学研究，这需要取消研究或在没有对比剂的情况下进行扫描。这两种方法都不理想。
我们在放射科实施了快速全血即时护理（POCT）肌酐检测（iSTAT，雅培即时护理），并评估了其对临床操作的影响。
在 7 个月的时间里，共进行了 3087 次肌酐检测。总体而言，5.3%（每月 441 例）接受扫描的患者没有最近的 eGFR 值。对 1 个月的肌酐/eGFR 值进行审核显示，74%的值正常，允许无需进一步考虑即可进行扫描。在异常值中，74%的患者使用了对比剂，26%的患者没有使用。值得注意的是，78%的 eGFR 异常患者的肌酐值正常。POCT 检测的成本为 10.06 美元，而在中央实验室进行的肌酐检测的成本为 5.32 美元（包括采血）。因此，POCT 检测的附加增量成本为 4.74 美元。
由于需要考虑许多复杂因素，包括对放射科工作流程的影响、更及时扫描的临床影响、进行或不进行对比剂扫描的临床和财务后果以及因差异报销率和支付者组合而导致的收入影响，因此快速检测的成本效益极难确定。然而，考虑到该检测对放射科操作以及对护理质量和及时性的益处，即时护理检测似乎具有成本效益，并改善了临床操作。
