CJEM Articles: point-of-care testing

Displaying 1-2 of 2 results

  • Emergency department visual urinalysis versus laboratory urinalysis
    November 2009 11 6
    James C. Worrall

    Objective: The primary objective of this study was to compare the results of nurse-performed urinalysis (NPU) interpreted visually in the emergency department (ED) with laboratory-performed urinalysis (LPU) interpreted by reflectance photometry.

    Methods: This was a prospective observational study based on a convenience sample from my emergency practice. Emer gency nurses, who were unaware of the study, performed usual dipstick analysis before sending the same urine sample to the laboratory for testing.

    Results: Of 140 urinalyses performed during the study period, 124 were suitable for analysis. When compared with the reference standard LPU, the NPU had an overall sensitivity of 100% (95% confidence interval [CI] 95%-100%) and a specificity of 49% (95% CI 33%-65%) for the presence of any 1 of blood, leukocyte esterase, nitrites, protein, glucose or ketones in the urine. Of 20 falsely positive NPUs, 18 were a result of the nurse recording 1 or more components as “trace” positive.

    Conclusion: Although NPU does not yield identical results to LPU, a negative LPU is expected when the initial NPU in the ED is negative.

  • Accuracy and speed of urine pregnancy tests done in the emergency department: a prospective study
    October 2001 3 4
    Cathy Dobson, Gerald C. Lazarenko, Rollin Brant, Rosemarie Enokson

    Objectives: Our primary objective was to assess the agreement between urine pregnancy tests done in the emergency department (ED) and those done by the Calgary Laboratory Services (CLS). Our secondary objective was to compare turnaround times for tests done in the ED and those done in the laboratory.
    Methods: This prospective study enrolled a convenience sample of ED patients who required a pregnancy test at 1 of 3 urban Calgary EDs. Using the same urine sample from each patient, testing was done in both the ED and by the CLS using the Abbott TestPak Plus (Abbott Laboratories, Mississauga, Ont.) urine pregnancy kit. The ED data included time of urine collection, ß-hCG (human chorionic gonadotropin) result, urine specific gravity, and the time the ED nurse reported the result. The CLS data included the time sample was sent to the laboratory, time of laboratory reporting, time ED nurse was aware of the result, the urine ß-hCG result and urine specific gravity. When the ED result and CLS result differed, a serum ß-hCG assay was performed and used as the diagnostic "gold standard."
    Results: There was a high level of agreement between the CLS and the ED, as indicated by a kappa value of 0.97 (95% confidence interval [CI], 0.95-0.98). The ED was significantly faster in time to initial report and time to availability on the chart, with mean differences of 25 minutes (95% CI, 22-27) and 60 minutes (95% CI, 56-64), respectively.
    Conclusions: ED nurses can perform urine pregnancy tests as accurately as laboratory technicians, and can provide results on which to base care much faster than the laboratory can. Point-of-care urine pregnancy testing may expedite the ED management of patients who require pregnancy tests.