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急诊患者的即时检验:现有证据的数量和质量。

Point-of-Care Testing for the Emergency Department Patient: Quantity and Quality of the Available Evidence.

机构信息

From the Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia.

出版信息

Arch Pathol Lab Med. 2021 Mar 1;145(3):308-319. doi: 10.5858/arpa.2020-0495-RA.

Abstract

CONTEXT.—: Point-of-care test (POCT) instruments produce lab results with rapid turnaround times. Based on that fact, emergency department (ED) POCT requests are predicated on the belief that rapid test turnaround times lead to improved care, typically a decreased ED length of stay (LOS).

OBJECTIVE.—: To compile the available peer-reviewed data regarding use of POCT in the ED with an emphasis on ED-LOS.

DATA SOURCES.—: An English-language PubMed search using the following free text terms: ("EMERGENCY" AND "POINT OF CARE") NOT ULTRASOUND as well as "RAPID INFECTIOUS DISEASE TESTING." In addition, the PubMed "similar articles" functionality was used to identify related articles that were not identified on the initial search.

CONCLUSIONS.—: Seventy-four references were identified that studied POCT ED use to determine if they resulted in significant changes in ED processes, especially ED-LOS. They were divided into 3 groups: viral-influenza (n = 24), viral-respiratory not otherwise specified (n = 8), and nonviral (n = 42). The nonviral group was further divided into the following groups: chemistry, cardiac, bacterial/strep, C-reactive protein, D-dimer, drugs of abuse, lactate, and pregnancy. Across all groups there was a trend toward a significantly decreased ED-LOS; however, a number of studies showed no change, and a third group was not assessed for ED-LOS. For POCT to improve ED-LOS it has to be integrated into existing ED processes such that a rapid test result will allow the patient to have a shorter LOS, whether it is to discharge or admission.

摘要

背景

床边检测(POCT)仪器可快速获得实验室结果。基于这一事实,急诊部(ED)POCT 请求的前提是相信快速检测周转时间可改善护理,通常可缩短 ED 住院时间(LOS)。

目的

编译有关 ED 中 POCT 使用的现有同行评审数据,重点关注 ED-LOS。

数据来源

使用以下自由文本术语在英语 PubMed 上进行搜索:(“紧急”和“床边”)而不是“超声”,以及“快速传染病检测”。此外,还使用了 PubMed 的“相似文章”功能来识别未在初始搜索中识别出的相关文章。

结论

确定了 74 项研究 POCT ED 使用情况的参考资料,以确定它们是否导致 ED 流程发生重大变化,尤其是 ED-LOS。它们分为 3 组:病毒-流感(n = 24)、病毒-呼吸道未特指(n = 8)和非病毒(n = 42)。非病毒组进一步分为以下组:化学、心脏、细菌/链球菌、C 反应蛋白、D-二聚体、滥用药物、乳酸和妊娠。在所有组中,ED-LOS 都呈明显下降趋势;然而,许多研究没有变化,第三组没有评估 ED-LOS。为了使 POCT 改善 ED-LOS,它必须整合到现有的 ED 流程中,以便快速检测结果可使患者的 LOS 缩短,无论是出院还是入院。

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