Comparison of the Quantra QPlus System With Thromboelastography in Cardiac Surgery.

OBJECTIVES: Use of viscoelastic testing, such as thromboelastography (TEG), is recommended in cardiac surgery to monitor coagulation and to guide the transfusion of blood products. The Quantra QPlus System is a novel point-of-care platform that uses ultrasonic pulses to characterize dynamic changes in viscoelastic properties of a blood sample during coagulation. Despite the ability to assess similar aspects of clot formation, limited studies addressing the interchangeability of viscoelastic testing parameters exist. The primary aim of the present study was to assess the correlation and agreement between Quantra and TEG5000 results using blood samples from cardiac surgery patients. DESIGN: Tertiary care, academic medical center. SETTING: Prospective observational study. PARTICIPANTS: Twenty-eight patients undergoing elective cardiac surgery undergoing cardiopulmonary bypass were evaluated. MEASUREMENTS AND MAIN RESULTS: Perioperative blood samples were collected and assessed using Quantra, and results were compared with TEG and conventional coagulation testing. Method comparison analysis demonstrated that Quantra parameters (Quantra clot time, clot stiffness, and fibrinogen contribution to clot stiffness) significantly correlated with TEG R and TEG G after induction of anesthesia, during cardiopulmonary bypass, and after rewarming (rs = 0.83, rs = 0.84, and rs = 0.73, respectively). However, Quantra parameters demonstrated poor agreement compared with equivalent TEG5000 parameters. CONCLUSIONS: The Quantra QPlus System significantly correlated with TEG5000, suggesting that this test may be used in a similar clinical context. Despite the strength of correlation between Quantra and TEG parameters, measurements are not interchangeable.

Comparison of the time required for manual (visually read) and semi-automated POCT urinalysis and pregnancy testing with associated electronic medical record (EMR) transcription errors.

BACKGROUND: POCT urinalysis (UA) and urine pregnancy tests (UPT) are routinely performed in obstetrics and gynecology (Ob/Gyn) clinics by dipstick and pregnancy test kit methods respectively. In this study, we compared the time, efficiency and accuracy of these tests using manual, visually read methods and a semi-automated analyzer that was not interfaced to the EMR. METHODS: We prospectively enrolled 2525 patients at five Ob/Gyn clinics. Urine samples were tested using three different dipsticks for UA (2, 7 and 10 test pads) and the Sure-Vue™ urine pregnancy test kit. The samples were analyzed on the CLINITEK Status® Connect System and results compared for time taken and errors in results' transcription. RESULTS: Using the CLINITEK Status Connect System, average test time and average total test time for UA dipsticks 7 and 10 test pads was significantly less than the manual, visually read method (0.77 and 0.64 min, respectively; p < 0.001). The average test time for manual, visually read Chem 2 was significantly less than the CLINITEK Status Connect System (0.09 min; p = 0.005), but not the average total test time (0.08 min; p = 0.33). Average test time for a negative UPT using the CLINITEK Status Connect System was significantly greater (0.87 min; p < 0.001). We found a transcription error rate of 0.3-1.7% for UA results and none for UPT. About 8% of UA and 12% of UPT results were not documented in EMR. CONCLUSION: The CLINITEK Status Connect System was more efficient than the manual, visually read process and if interfaced with the EMR would eliminate errors and non-documentation of results.