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Accuracy and feasibility of point-of-care white blood cell count and C-reactive protein measurements at the pediatric emergency department.

ABSTRACT: Several point-of-care (POC) tests are available for evaluation of febrile patients, but the data about their performance in acute care setting is sparse. We investigated the analytical accuracy and feasibility of POC tests for white blood cell (WBC) count and C-reactive protein (CRP) at the pediatric emergency department (ED).In the first part of the study, HemoCue WBC and Afinion AS100 CRP POC analyzers were compared with laboratory's routine WBC (Sysmex XE-2100) and CRP (Modular P) analyzers in the hospital central laboratory in 77 and 48 clinical blood samples, respectively. The POC tests were then adopted in use at the pediatric ED. In the second part of the study, we compared WBC and CRP levels measured by POC and routine methods during 171 ED patient visits by 168 febrile children and adolescents. Attending physicians performed POC tests in capillary fingerprick samples.In parallel measurements in the laboratory both WBC and CRP POC analyzers showed good agreement with the reference methods. In febrile children at the emergency department (median age 2.4 years), physician performed POC determinations in capillary blood gave comparable results with those in venous blood analyzed in the laboratory. The mean difference between POC and reference test result was 1.1 E9/L (95% limits of agreement from -6.5 to 8.8 E9/L) for WBC and -1.2 mg/L (95% limits of agreement from -29.6 to 27.2 mg/L) for CRP.POC tests are feasible and relatively accurate methods to assess CRP level and WBC count among febrile children at the ED.

SUBMITTER: Ivaska L

PROVIDER: S-EPMC4452774 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Accuracy and feasibility of point-of-care white blood cell count and C-reactive protein measurements at the pediatric emergency department.

Ivaska Lauri L Niemelä Jussi J Leino Pia P Mertsola Jussi J Peltola Ville V

PloS one 20150602 6

<h4>Background</h4>Several point-of-care (POC) tests are available for evaluation of febrile patients, but the data about their performance in acute care setting is sparse. We investigated the analytical accuracy and feasibility of POC tests for white blood cell (WBC) count and C-reactive protein (CRP) at the pediatric emergency department (ED).<h4>Methods</h4>In the first part of the study, HemoCue WBC and Afinion AS100 CRP POC analyzers were compared with laboratory's routine WBC (Sysmex XE-21 ...[more]

PMID: 26034987

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Project description:IntroductionChildren with food insecurity (FI) experience adverse health outcomes due to inadequate quantity or quality of food. Food insecurity may be high among families seeking emergency care. The Hunger Vital Sign (HVS) is a two-question validated tool used to screen families for FI. Our goal in this study was to assess prevalence of FI among emergency department (ED) patients, patient-level risk factors for FI, and the feasibility of screening.MethodsThis was a cross-sectional analysis of FI in the ED. Parents or guardians of ED patients and adult patients (18 years or older) were approached for screening using the HVS during screening periods spanning weekdays/weekends and days/evenings. All ED patients were eligible, excluding siblings, repeat visits, critically ill patients, minors without a guardian, and families that healthcare staff asked us not to disturb. Families answered the HVS questions verbally or in writing, based on preference. Families with positive screens received information about food resources. We summarized patient and visit characteristics and defined medical complexity using a published algorithm. Multivariable logistic regression was used to assess FI risk factors.ResultsIn July-August 2019, 527 patients presented during screening periods: 439 agreed to screening, 18 declined, 19 met exclusions, and 51 were missed. On average the screening tool required five minutes (range 3-10 minutes) to complete. Most families (328; 75%) preferred to answer in writing rather than verbally. Overall, 77 participants (17.5%) screened positive for FI. In regression analyses, FI was associated with self-reported race/ethnicity (combined variable) of African American or Black (odds ratio [OR] 5.21, 95% confidence interval [CI], 2.13-12.77), Hispanic (OR 3.47, 95% CI, 1.48-8.15), or mixed/other (OR 3.81, 95% CI, 1.54-9.39), compared to non-Hispanic white. FI was also associated with public insurance type (OR 5.74, 95% CI, 2.52-13.07, reference: private insurance), and each year of increasing patient age (OR 1.05, 95% CI, 1.01-1.09). There were no associations between FI and medical complexity or preferred language.ConclusionFood insecurity was common among our ED patients. Race and ethnicity, insurance status, and increasing patient age were associated with increased odds of FI. Efforts to include universal FI screening for ED patients with immediate connection to resources will enhance overall care quality and address important health needs.

Project description:ObjectivesThe objective was to evaluate the diagnostic accuracy of five health literacy screening instruments in emergency department (ED) patients: the Rapid Evaluation of Adult Literacy in Medicine-Revised (REALM-R), the Newest Vital Sign (NVS), Single Item Literacy Screens (SILS), health numeracy, and physician gestalt. A secondary objective was to evaluate the feasibility of these instruments as measured by administration time, time on task, and interruptions during test administration.MethodsThis was a prospective observational cross-sectional study of a convenience sampling of adult patients presenting during March 2011 and February 2012 to one urban university-affiliated ED. Subjects were consenting non-critically ill, English-speaking patients over the age of 18 years without aphasia, dementia, mental retardation, or inability to communicate. The diagnostic test characteristics of the REALM-R, NVS, SILS, health numeracy, and physician gestalt were quantitatively assessed by using the short Test of Functional Health Literacy in Adults (S-TOFHLA). A score of 22 or less was the criterion standard for limited health literacy (LHL).ResultsA total of 435 participants were enrolled, with a mean (±SD) age of 45 (±15.7) years, and 18% had less than a high school education. As defined by an S-TOFHLA score of 22 or less, the prevalence of LHL was 23.9%. In contrast, the NVS, REALM-R, and physician gestalt identified 64.8, 48.5, and 35% of participants as LHL, respectively. A normal NVS screen was the most useful test to exclude LHL, with a negative likelihood ratio of 0.04 (95% confidence interval [CI] = 0.01 to 0.17). When abnormal, none of the screening instruments, including physician gestalt, significantly increased the posttest probability of LHL. The NVS and REALM-R require 3 and 5 minutes less time to administer than the S-TOFHLA. Administration of the REALM-R is associated with fewer test interruptions.ConclusionsOne-quarter of these ED patients had marginal or inadequate health literacy. Among the brief screening instruments evaluated, a normal NVS result accurately reduced the probability of LHL, although it will identify two-thirds of ED patients as high risk for LHL. None of the brief screening instruments significantly increases the probability of LHL when abnormal.

Project description:ObjectivesPoint-of-care ultrasound (POCUS) may facilitate the diagnosis and management of children for various conditions. Integration of POCUS into clinical care requires hands-on training; however, providers may be reluctant to perform educational ultrasounds to improve their skills, as it is a procedure without direct clinical benefit to the patient and due to concerns that it may lower a family's overall satisfaction. We sought to evaluate whether the use of POCUS changed overall patient/caregiver satisfaction in a pediatric emergency department (ED) visit.MethodsWe performed a prospective cohort study of children presenting to a single children's hospital ED. We evaluated overall satisfaction for three groups: 1) children undergoing POCUS for educational purposes, 2) children undergoing POCUS for a specific diagnostic indication, and 3) controls who did not receive POCUS. Overall satisfaction was measured using a 100-point visual analog scale (VAS). We performed a noninferiority test between patients receiving POCUS and controls using a delta of 10 points to determine significance. We also examined satisfaction among patients receiving diagnostic ultrasound and sought to determine patient/caregiver satisfaction with specific elements of the POCUS experience.ResultsWe surveyed 159 patients who presented between April 2016 and August 2016 (53 in each group). The three groups did not differ with respect to patient age, sex, or Emergency Severity Index level. The median VAS scores for both the educational and the diagnostic POCUS groups (94 and 94, respectively) were not inferior to the VAS score for the control group (91) with a median (95% confidence interval [CI]) difference of 3.0 (-2.2 to 8.2) for educational and control groups and 3.0 (-1.6 to 7.6) for diagnostic and control groups. No patients/caregivers in the educational POCUS group would refuse an educational ultrasound during a future medical encounter.ConclusionEducational POCUS does not decrease patient/caregiver satisfaction among children presenting to the ED.

Dataset Information

Accuracy and feasibility of point-of-care white blood cell count and C-reactive protein measurements at the pediatric emergency department.

Publications

Accuracy and feasibility of point-of-care white blood cell count and C-reactive protein measurements at the pediatric emergency department.

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