Dataset Information

Accuracy of point-of-care crossmatching methods and crossmatch incompatibility in critically ill dogs.

ABSTRACT:

Background

The performance of commercial point-of-care crossmatch (CM) tests compared to laboratory tube agglutination CM is unknown. Additionally, there is limited information regarding CM incompatibility in ill dogs.

Objectives

To determine if point-of-care major CM methods are accurate in detecting compatible and incompatible tests when compared to laboratory CM methods, and to identify factors associated with CM incompatibility in dogs.

Animals

Part 1 (prospective) included 63 client-owned dogs potentially requiring blood transfusion. Part 2 (retrospective) included all dogs from part 1, plus medical records of 141 dogs with major CM results.

Methods

For part 1, major CM was performed using a tube agglutination assay (LAB-CM), a gel-based point-of-care test (GEL-CM), and an immunochromatographic point-of-care test (IC-CM). For part 2, medical record data were collected to determine rates of and risk factors for CM incompatibility.

Results

Kappa agreement between the LAB-CM and GEL-CM methods could not be calculated due to a relative lack of incompatible results. Kappa agreement between the LAB-CM and IC-CM methods was 0.16 (95% confidence interval [CI] = 0-0.31, P = .007) indicating no agreement. The LAB-CM incompatibility in transfusion-naïve vs dogs that had a transfusion was 25% and 35%, (P = .3).

Conclusions and clinical importance

Compared to laboratory methods, point-of-care methods evaluated in our study lacked sensitivity for detecting incompatibilities. Dogs had similar rates of major CM incompatibility regardless of transfusion history. This suggests CM testing prior to transfusion be considered in all dogs however our study did not investigate clinical relevancy of incompatible LAB-CM.

SUBMITTER: Marshall H

PROVIDER: S-EPMC7848312 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Publications

Accuracy of point-of-care crossmatching methods and crossmatch incompatibility in critically ill dogs.

Marshall Hayden H Blois Shauna L SL Abrams-Ogg Anthony C G ACG Bersenas Alexa M AM Ruotsalo Kristiina K Monteith Gabrielle G

Journal of veterinary internal medicine 20201218 1

<h4>Background</h4>The performance of commercial point-of-care crossmatch (CM) tests compared to laboratory tube agglutination CM is unknown. Additionally, there is limited information regarding CM incompatibility in ill dogs.<h4>Objectives</h4>To determine if point-of-care major CM methods are accurate in detecting compatible and incompatible tests when compared to laboratory CM methods, and to identify factors associated with CM incompatibility in dogs.<h4>Animals</h4>Part 1 (prospective) incl ...[more]

PMID: 33336866

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Project description:IntroductionPoint-of-care ultrasound (POCUS) use is increasing in pediatric clinical settings. However, gastric POCUS is rarely used, despite its potential value in optimizing the diagnosis and management in several clinical scenarios (i.e., assessing gastric emptying and gastric volume/content, gastric foreign bodies, confirming nasogastric tube placement, and hypertrophic pyloric stenosis). This review aimed to assess how gastric POCUS may be used in acute and critically ill children.Materials and methodsAn international expert group was established, composed of pediatricians, pediatric intensivists, anesthesiologists, radiologists, nurses, and a methodologist. A scoping review was conducted with an aim to describe the use of gastric POCUS in pediatrics in acute and critical care settings. A literature search was conducted in three databases, to identify studies published between 1998 and 2022. Abstracts and relevant full texts were screened for eligibility, and data were extracted, according to the JBI methodology (Johanna Briggs Institute).ResultsA total of 70 studies were included. Most studies (n = 47; 67%) were conducted to assess gastric emptying and gastric volume/contents. The studies assessed gastric volume, the impact of different feed types (breast milk, fortifiers, and thickeners) and feed administration modes on gastric emptying, and gastric volume/content prior to sedation or anesthesia or during surgery. Other studies described the use of gastric POCUS in foreign body ingestion (n = 6), nasogastric tube placement (n = 5), hypertrophic pyloric stenosis (n = 8), and gastric insufflation during mechanical ventilatory support (n = 4). POCUS was performed by neonatologists, anesthesiologists, emergency department physicians, and surgeons. Their learning curve was rapid, and the accuracy was high when compared to that of the ultrasound performed by radiologists (RADUS) or other gold standards (e.g., endoscopy, radiography, and MRI). No study conducted in critically ill children was found apart from that in neonatal intensive care in preterms.DiscussionGastric POCUS appears useful and reliable in a variety of pediatric clinical settings. It may help optimize induction in emergency sedation/anesthesia, diagnose foreign bodies and hypertrophic pyloric stenosis, and assist in confirming nasogastric tube placement, avoiding delays in obtaining confirmatory examinations (RADUS, x-rays, etc.) and reducing radiation exposure. It may be useful in pediatric intensive care but requires further investigation.

Project description:Outcomes data on point-of-care ultrasound (POCUS) in critically ill patients are lacking. This study examines the association between POCUS in the emergency department and outcomes in critically ill patients.DesignRetrospective cohort study of critically ill emergency department patients in two academic emergency departments. All emergency department patients admitted to the intensive care unit or that die in the emergency department were entered prospectively into a registry.SettingTwo academic emergency departments.PatientsAll adult (> 18 years old) non-trauma patients with hemodynamic instability [shock index (heart rate/systolic blood pressure) > 0.6] between November 1, 2013-October 31, 2016, were included.InterventionsCohorts were assigned as follows: no POCUS (cohort 1), POCUS prior to a key intervention (cohort 2), and POCUS after a key intervention (cohort 3). A key intervention was either a fluid bolus or vasoactive drug initiation.Measurements and main resultsMultivariable logistic regression was used to evaluate the association between POCUS use and the primary outcome of in-hospital mortality. We conducted several sensitivity analyses including propensity score matching and inverse-probability-weighted regression-adjustment along with multiple imputation to account for non-random assignment of POCUS as well as bias due to missing data. Of the 7,734 eligible patients, 2,293 patients were excluded. The remaining 5,441 patients were included in the analysis: 4165 in Cohort 1, 614 in Cohort 2, and 662 in Cohort 3. Mortality was 22%, 29%, and 26%, respectively (p < 0.001). POCUS prior to an intervention was associated with an adjusted odds ratio for death of 1.41 (95% CI, 1.12-1.76) compared to no POCUS. The sensitivity analyses showed an absolute increased mortality of +0.05 (95% CI, 0.02-0.09) for cohort 2 compared to 1.ConclusionsPOCUS use prior to interventions appears to be associated with care delays and increased in-hospital mortality compared to critically ill patients with no POCUS. Further explorations of the impact of POCUS in the emergency department appear warranted.

Dataset Information

Accuracy of point-of-care crossmatching methods and crossmatch incompatibility in critically ill dogs.

Background

Objectives

Animals

Methods

Results

Conclusions and clinical importance

Publications

Accuracy of point-of-care crossmatching methods and crossmatch incompatibility in critically ill dogs.

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