Singer Adam J, Taylor Merry, LeBlanc Deborah, Meyers Kristen, Perez Karol, Thode Henry C, Pines Jesse M
Department of Emergency Medicine, Stony Brook University, Stony Brook, New York.
Department of Emergency Medicine, George Washington University, Washington, DC.
J Emerg Med. 2018 Aug;55(2):172-178. doi: 10.1016/j.jemermed.2018.04.061. Epub 2018 Jun 7.
Core laboratory testing may increase length of stay and delay care.
We compared length of emergency department (ED) care in patients receiving point-of-care testing (POCT) at triage vs. traditional core laboratory testing.
We conducted a prospective, case-controlled trial of adult patients with prespecified conditions requiring laboratory testing and had POCT performed by a nurse after triage for: a basic metabolic panel, troponin I, lactate, INR (i-STAT System), urinalysis (Beckman Coulter Icon), or urine pregnancy test. Study patients were matched with controls based on clinical condition, gender, age, and time to be seen. Groups were compared with Wilcoxon rank-sum or Fisher's exact tests.
We matched 52 POCT study patients with 52 controls. Groups were similar in age, gender, clinical condition, time to be seen by a physician (3.3 h, 95% confidence interval [CI] 2.2-4.4, vs. 3.1 h, 95% CI 2.2-4.5 h, in POCT and control patients, respectively; p = 0.84), use of imaging, and disposition. Of 52 study patients, 3 (5.8%, 95% CI 2.0-15.9) were immediately transferred to the critical care area to be urgently seen by an emergency physician. POCT patients had a significantly shorter median (interquartile range [IQR]) ED care time than matched controls (7.6, 95% CI 5.1-9.5 vs. 8.5, 6.2-11.3 h, respectively; p = 0.015). Median [IQR] ED length of stay was similar in study patients and controls (9.6, 95% CI 7.9-14.5 vs. 12.5, 8.2-21.2 h, respectively; p = 0.15).
Among stable adult patients presenting to the ED with one of the prespecified conditions, early POCT at triage, compared with traditional core laboratory testing after evaluation by an ED provider, reduced ED care time by approximately 1 h.
核心实验室检测可能会延长住院时间并延误治疗。
我们比较了在分诊时接受即时检验（POCT）的患者与接受传统核心实验室检测的患者的急诊科（ED）护理时长。
我们对患有特定疾病需要进行实验室检测的成年患者进行了一项前瞻性病例对照试验，分诊后由护士对患者进行以下项目的即时检验：基本代谢指标、肌钙蛋白I、乳酸、国际标准化比值（i-STAT系统）、尿液分析（贝克曼库尔特Icon）或尿妊娠试验。根据临床状况、性别、年龄和就诊时间将研究患者与对照组进行匹配。采用Wilcoxon秩和检验或Fisher精确检验对两组进行比较。
我们将52例接受即时检验的研究患者与52例对照组患者进行了匹配。两组在年龄、性别、临床状况、医生就诊时间（即时检验组为3.3小时，95%置信区间[CI]为2.2 - 4.4小时；对照组为3.1小时，95%CI为2.2 - 4.5小时；p = 0.84）、影像学检查的使用情况及处置方式方面相似。在52例研究患者中，3例（5.8%，95%CI为2.0 - 15.9）被立即转至重症监护区，由急诊医生紧急诊治。即时检验组患者的急诊护理时间中位数（四分位间距[IQR]）显著短于匹配的对照组（分别为7.6小时，95%CI为5.1 - 9.5小时和8.5小时，6.2 - 11.3小时；p = 0.015）。研究患者和对照组的急诊住院时间中位数[IQR]相似（分别为9.6小时，95%CI为7.9 - 14.5小时和12.5小时，8.2 - 21.2小时；p = 0.15）。
在因特定疾病之一就诊于急诊科的稳定成年患者中，与急诊科医护人员评估后进行传统核心实验室检测相比，分诊时早期进行即时检验可将急诊护理时间缩短约1小时。
