Validation of a hand-held point of care device for lactate in adult and pediatric patients using traditional and locally-smoothed median and maximum absolute difference curves

Colón-Franco, Jessica M; Lo, Stanley F.; Tarima, Sergey; Gourlay, David M.; Drendel, Amy L.; Lerner, EB

doi:10.1016/j.cca.2017.02.015

Cited by 16 publications

(8 citation statements)

References 16 publications

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“…Several studies have evaluated the SSX’s in-hospital accuracy and found it as accurate as larger stationary laboratory equipment [ 10 , 11 ]. Colon-Franco et al analysed discarded blood samples in a laboratory to evaluate the accuracy of the SSX compared to the Radiometer ABL800 FLEX (ABL800) [ 9 ]. In accordance with our findings, they found good agreement between the two devices’ measurements and a systematic negative bias on the SSX results compared to the ABL800, especially when the blood lactate level were above 4 mmol/L.…”

Section: Discussionmentioning

confidence: 99%

“…Minimum sample size was calculated using the statistical software MedCalc®. An expected mean of difference = 0.3 mmol/L and an expected SD of difference = 0.6 was chosen according to the results seen in a previous study [ 9 ]. Maximum allowed difference between methods was in this previous study set to 0.3 mmol/L, but the same study also found that the SSX measured systematically lower lactate concentrations compared to the ABL800.…”

Section: Methodsmentioning

confidence: 99%

“…Their accuracies are tested within laboratories and in hospitals in standardized settings, usually under controlled circumstances including both the preparation of the skin before obtaining the blood sample and the ambient temperature and humidity. Most of these validation studies have shown acceptable results compared to larger-and calibrated-stationary laboratory devices [9][10][11]. Although in theory very useful in the prehospital setting, the accuracies of the handheld devices are yet to be determined in prehospital settings.…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of a point-of-care blood lactate measurement device in a prehospital setting

Hansen

Zegers

Nybo

et al. 2022

J Clin Monit Comput

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Point-of-care blood lactate is a promising prognostic biomarker of short-term mortality risk. Portable lactate meters need validation in the prehospital setting before widespread implementation and it is unknown whether the mode of sampling (arterial, capillary or venous) matters. This study aims to compare the StatStrip Xpress Lactate Meter’s (SSX) accuracy to a validated blood gas analyser, ABL90 FLEX (ABL90), in arterial samples in the prehospital environment and to determine if lactate levels measured in venous and capillary blood samples are sufficiently accurate compared to arterial lactate levels. Patients with arterial samples drawn by the prehospital anaesthesiologist for any reason were eligible for inclusion. Simultaneously, three blood samples (arterial, capillary and venous) were analysed on SSX and arterial blood on ABL90. Measurements of agreements were evaluated by Lin’s concordance correlations coefficient (CCC) and Bland–Altman Plots. One-hundred-and-eleven patients were included. SSX showed good accuracy compared to ABL90 in arterial samples with a CCC of 0.92 (95% CI 0.90–0.94). Compared to the arterial samples measured on ABL90, venous samples analysed on SSX showed higher agreement than capillary samples analysed on SSX with CCCs of 0.88 (95% CI 0.85–0.91) and 0.79 (95% CI 0.72–0.85), respectively. Bland–Altman plots showed that SSX lactate measurements in arterial, venous and capillary blood samples all had systematically negative biases compared to ABL90. We conclude that the SSX is accurate in our prehospital setting. Venous samples should be preferred over capillary samples, when arterial samples cannot be obtained.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Accuracy of a point-of-care blood lactate measurement device in a prehospital setting

Hansen

Zegers

Nybo

et al. 2022

J Clin Monit Comput

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“…The measurement is based on an electrochemical reaction when lactate in whole blood reacts with the strip inserted in the SSX that 7 Feasibility of the SSX has been demonstrated in a prehospital setting, with acceptable reproducibility and concordance at clinically relevant concentrations compared to standard laboratory devices, albeit with proportional negative bias in higher concentrations. [15][16][17][18] The instrument was validated by the EMS before the study. ED physicians have access to the EMS Ambulink records where the prehospital lactate value was visible.…”

Section: Prehospital Lactatementioning

confidence: 99%

Prehospital lactate levels in blood as a seizure biomarker: A multi‐center observational study

et al. 2021

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Objective The objective of this study was to assess the value of prehospital measurement of lactate level in blood for diagnosis of seizures in cases of transient loss of consciousness. Methods Between March 2018 and September 2019, prehospital lactate was measured with a point‐of‐care device by the emergency medical services in an area serving a population of 900 000. A total of 383 cases of transient loss of consciousness were identified and categorized as tonic‐clonic seizure (TCS), other seizure, syncope, or other cause, according to the final diagnosis in the electronic medical records system. Receiver operating characteristic curve analyses were used to identify the optimal lactate cut‐off. Results A total of 383 cases were included (135 TCS, 42 other seizure, 163 syncope, and 43 other causes). The median lactate level in TCS was 7.0 mmol/L, compared to a median of 2.0 mmol/L in all other cases (P < .001). The area under the curve (AUC) of TCS vs nonepileptic causes was 0.87 (95% confidence interval [CI] 0.83‐0.91). The optimal cut‐off (Youden index, 67.8%) was 4.75 mmol/L, with 79% sensitivity (95% CI 71‐85) and 89% specificity (95% CI 85‐93) for TCS. Significance Prehospital lactate can be a valuable tool for identifying seizures in transient loss of consciousness. For acceptable specificity, a higher cut‐off than that previously demonstrated for hospital‐based measurements must be used when values obtained close to the time of the event are interpreted.

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“…Prehospital lactate measurements became available to AAKSS HEMS teams as an adjunct to clinical assessment in July 2017 using the NOVA StatStrip® Biomedical Xpress™ Point of care (POCT) Lactate Meter system [9,10]. Current AAKSS Standard Operating Procedures (SOP), recommend lactate measurement in all patients with suspected major hemorrhage.…”

Section: Lactate Measurementmentioning

confidence: 99%

Determinants of prehospital lactate in trauma patients: a retrospective cohort study

Avest¹,

Griggs²,

Wijesuriya³

et al. 2020

BMC Emerg Med

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Background: Point of care serum lactate measurement is emerging as an adjunct to prehospital clinical assessment and has the potential to guide triage and advanced treatment decision-making. In this study we aimed to assess which factors potentially affect prehospital lactate levels. Methods: We performed a retrospective cohort study of all trauma patients attended by the Air Ambulance, Kent, Surrey & Sussex (AAKSS) between July 2017 and April 2018 in whom a pre-hospital lactate was measured. Lactate was measured before AAKSS treatments were commenced, but generally after prehospital treatment by ground ambulance crews was initiated. Primary endpoint of interest was the association of various patient-and treatment characteristics with prehospital lactate levels. Results: During the study period, lactate was measured in 156 trauma patients. Median lactate was 3.0 [2.0-4.1] mmol/l. Patients with an elevated lactate more often had deranged indices of end organ perfusion-and oxygenation (shock index 0.80 [0.58-1.03] vs 0.61 [0.40-0.82], p < 0.001, SpO 2 96 [89-100%] vs 98 [96-100%], p = 0.025). They more often suffered from head injuries (62% vs 41%, p = 0.008), and received less analgesia prior to arrival of the AAKSS team (51.6% vs 67.2%, p = 0.03). In multivariate analysis, indices of end organ perfusion-and oxygenation only explained 15% of the variation in lactate levels. Conclusions: Prehospital lactate levels are not solely associated with indices of end organ perfusion-and oxygenation. Injury type, treatments given on scene and many other (unmeasured) factors likely play an important role as well. This should be taken into account when lactate is used in clinical algorithms to guide prehospital triage or treatment.

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Validation of a hand-held point of care device for lactate in adult and pediatric patients using traditional and locally-smoothed median and maximum absolute difference curves

Cited by 16 publications

References 16 publications

Accuracy of a point-of-care blood lactate measurement device in a prehospital setting

Accuracy of a point-of-care blood lactate measurement device in a prehospital setting

Prehospital lactate levels in blood as a seizure biomarker: A multi‐center observational study

Determinants of prehospital lactate in trauma patients: a retrospective cohort study

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