Lasfer Chafika, Lahib Amal, Soliman Kariem, Gouda Shahinaz
Emergency Medicine, Fakeeh University Hospital, Dubai, ARE.
Cureus. 2025 Jul 31;17(7):e89106. doi: 10.7759/cureus.89106. eCollection 2025 Jul.
Background Point-of-care testing (POCT) is widely employed in emergency departments (EDs) for rapid clinical decision-making. However, the reliability of POCT for assessing critical electrolytes like potassium (K⁺) and sodium (Na⁺), compared to central laboratory methods, remains under scrutiny. Objective This quality improvement (QI) study aimed to evaluate and improve the reliability of POC venous blood gas (VBG) testing for K⁺ and Na⁺ by comparing results with central laboratory values. Structured within a Plan-Do-Study-Act (PDSA) cycle, the objectives included quantifying the analytical concordance using Pearson correlation and Bland-Altman methods, identifying systematic bias or clinical outliers, and assessing turnaround time (TAT) to inform iterative improvements in POCT protocol integration within the ED. Methods A retrospective audit was conducted on 120 patients (N = 120, 100%) at Fakeeh University Hospital, Dubai, from March to May 2023. Paired K⁺ and Na⁺ values from POCT VBG analyzers and laboratory reports were compared. Statistical analysis included scatter plots, Pearson correlation, and Bland-Altman agreement. Results Of the 120 patients, 65 (54.2%) were male and 55 (45.8%) were female, with a mean age of 47.3 years (SD = 16.1). Chief presentations included chest pain (N = 38, 31.7%), dyspnea (N = 32, 26.7%), vomiting (N = 23, 19.2%), and signs of dehydration (N = 27, 22.5%). POCT K⁺ and Na⁺ values showed strong correlation with laboratory values (r = 0.91 and r = 0.88, respectively). The mean bias for K⁺ was +0.12 mmol/L, and for Na⁺ it was -1.2 mmol/L. TAT was significantly shorter for POCT (mean = 2.4 minutes) versus laboratory results (mean = 12.3 minutes), with a median delay of 10 minutes. Conclusion POCT demonstrated high reliability for K⁺ and Na⁺ evaluation in EDs. However, caution is advised when interpreting extreme values, especially hyperkalemia (> 5.5 mmol/L). Central laboratory confirmation should be considered in borderline or critical cases.
即时检验（POCT）在急诊科（ED）中被广泛用于快速临床决策。然而，与中心实验室方法相比，POCT用于评估钾（K⁺）和钠（Na⁺）等关键电解质的可靠性仍在受到审查。
本质量改进（QI）研究旨在通过将结果与中心实验室值进行比较，评估并提高POC静脉血气（VBG）检测K⁺和Na⁺的可靠性。该研究以计划-执行-研究-行动（PDSA）循环为框架，目标包括使用Pearson相关性和Bland-Altman方法量化分析一致性，识别系统偏差或临床异常值，并评估周转时间（TAT），以为急诊科内POCT方案整合的迭代改进提供信息。
对迪拜Fakeeh大学医院2023年3月至5月的120例患者（N = 120，100%）进行回顾性审计。比较了POCT VBG分析仪和实验室报告中的配对K⁺和Na⁺值。统计分析包括散点图、Pearson相关性和Bland-Altman一致性分析。
120例患者中，男性65例（54.2%），女性55例（45.8%），平均年龄47.3岁（标准差 = 16.1）。主要临床表现包括胸痛（N = 38，31.7%）、呼吸困难（N = 32，26.7%）、呕吐（N = 23，19.2%）和脱水体征（N = 27，22.5%）。POCT K⁺和Na⁺值与实验室值显示出强相关性（分别为r = 0.91和r = 0.88）。K⁺的平均偏差为+0.12 mmol/L，Na⁺的平均偏差为-1.2 mmol/L。POCT的TAT明显短于实验室结果（平均 = 2.4分钟对平均 = 12.3分钟），中位延迟为10分钟。
POCT在急诊科对K⁺和Na⁺评估显示出高可靠性。然而，在解释极端值时，尤其是高钾血症（> 5.5 mmol/L）时应谨慎。在临界或危急情况下应考虑中心实验室确认。
