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1.
Artículo en Inglés | MEDLINE | ID: mdl-32411619

RESUMEN

The availability of pathogen-specific treatment options for respiratory tract infections (RTIs) increased the need for rapid diagnostic tests. Besides, retrospective studies, improved lab-based detection methods and the intensified search for new viruses since the beginning of the twenty-first century led to the discovery of several novel respiratory viruses. Among them are human bocavirus (HBoV), human coronaviruses (HCoV-HKU1, -NL63), human metapneumovirus (HMPV), rhinovirus type C (RV-C), and human polyomaviruses (KIPyV, WUPyV). Additionally, new viruses like SARS coronavirus (SARS-CoV), MERS coronavirus (MERS-CoV), novel strains of influenza virus A and B, and (most recently) SARS coronavirus 2 (SARS-CoV-2) have emerged. Although clinical presentation may be similar among different viruses, associated symptoms may range from a mild cold to a severe respiratory illness, and thus require a fast and reliable diagnosis. The increasing number of commercially available rapid point-of-care tests (POCTs) for respiratory viruses illustrates both the need for this kind of tests but also the problem, i.e., that the majority of such assays has significant limitations. In this review, we summarize recently published characteristics of POCTs and discuss their implications for the treatment of RTIs. The second key aspect of this work is a description of new and innovative diagnostic techniques, ranging from biosensors to novel portable and current lab-based nucleic acid amplification methods with the potential future use in point-of-care settings. While prototypes for some methods already exist, other ideas are still experimental, but all of them give an outlook of what can be expected as the next generation of POCTs.


Asunto(s)
Enfermedades Transmisibles Emergentes/diagnóstico , Enfermedades Transmisibles Emergentes/virología , Pruebas en el Punto de Atención , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/virología , Técnicas Biosensibles/métodos , Virus ADN/aislamiento & purificación , Humanos , Reacción en Cadena de la Polimerasa/métodos , Virus ARN/aislamiento & purificación
2.
Artículo en Inglés | MEDLINE | ID: mdl-32224986

RESUMEN

The breakthrough of novel coronavirus (2019-nCoV) in Wuhan, a city of China, has damaged the status of health and quality of life. In the sequel of this epidemic or contagious disease, the patient experiences fever, chest paint, chills, a rapid heartbeat, breathing difficulties, pneumonia, and kidney failure. It has been suggested that this disease can spread through human-to-human transmission or by super spreading. By the help of the non-invasive fluid "saliva", it is easy to detect the virus. This can help with the comfort of the patient as well as healthcare personnel. Under this perspective, we discuss the epidemic situation of 2019-nCOV and its relationship with human saliva.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Coronavirus , Neumonía Viral/diagnóstico , Pruebas en el Punto de Atención , Saliva/virología , Betacoronavirus , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Brotes de Enfermedades , Transmisión de Enfermedad Infecciosa , Fiebre/etiología , Humanos , Pandemias , Neumonía Viral/virología , Saliva/química
3.
ACS Nano ; 14(4): 3822-3835, 2020 04 28.
Artículo en Inglés | MEDLINE | ID: mdl-32223179

RESUMEN

COVID-19 has spread globally since its discovery in Hubei province, China in December 2019. A combination of computed tomography imaging, whole genome sequencing, and electron microscopy were initially used to screen and identify SARS-CoV-2, the viral etiology of COVID-19. The aim of this review article is to inform the audience of diagnostic and surveillance technologies for SARS-CoV-2 and their performance characteristics. We describe point-of-care diagnostics that are on the horizon and encourage academics to advance their technologies beyond conception. Developing plug-and-play diagnostics to manage the SARS-CoV-2 outbreak would be useful in preventing future epidemics.


Asunto(s)
Betacoronavirus/patogenicidad , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Pruebas en el Punto de Atención , Teléfono Inteligente , Humanos , Aplicaciones Móviles , Técnicas de Amplificación de Ácido Nucleico , Pandemias , Vigilancia de la Población , Reacción en Cadena en Tiempo Real de la Polimerasa , Tomografía Computarizada por Rayos X , Proteínas Virales/análisis
4.
BMC Infect Dis ; 20(1): 303, 2020 Apr 22.
Artículo en Inglés | MEDLINE | ID: mdl-32321447

RESUMEN

BACKGROUND: This study aimed to establish and evaluate a simultaneous amplification and testing method for detection of extra-pulmonary tuberculosis (EPTB). METHODS: From January 2016 and December 2017 the pus or surgical excision from the lesions of inpatients admitted from Chongqing Public Health Treatment Center were collected. According to the clinical diagnosis, the samples were divided into two groups including EPTB (Group A) and other diseases excluded from tuberculosis diseases (Group B). Simultaneous detection of Mycobacterium tuberculosis (MTB) used Roche culture method, liquid culture method and simultaneous amplification and testing (SAT) method. The sensitivity and specificity of the SAT method were compared with culture methods and clinical diagnosis of EPTB. RESULTS: For 433 EPTB specimens and 49 non-TB specimens, the simultaneous amplification and testing tuberculosis (SAT-TB) results correlated with 80.5% (388/482 specimens) of the culture assay results. The sensitivity, specificity, and positive and negative predictive values of the SAT-TB test for the diagnosis of EPTB were 83.6, 79.4, 59.4, and 93.0%, respectively, compared to culture methods. Compared with the clinical diagnosis of patients, the sensitivity and specificity of the SAT-TB test were 41.6 and 100%, respectively, the cultures test were 29.3 and 98.0%. CONCLUSIONS: SAT test is a simple and rapid test with high specificity which may enhance the detection of EPTB. SAT-TB is a higher clinical diagnosis value for EPTB in clinical microbiology laboratories.


Asunto(s)
Colorantes Fluorescentes/análisis , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/aislamiento & purificación , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Tuberculosis/diagnóstico , Reacciones Falso Negativas , Fluorescencia , Colorantes Fluorescentes/metabolismo , Humanos , Técnicas Microbiológicas/métodos , Pruebas en el Punto de Atención , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Factores de Tiempo , Tuberculosis/microbiología
5.
Emerg Microbes Infect ; 9(1): 747-756, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32196430

RESUMEN

The three unprecedented outbreaks of emerging human coronavirus (HCoV) infections at the beginning of the twenty-first century have highlighted the necessity for readily available, accurate and fast diagnostic testing methods. The laboratory diagnostic methods for human coronavirus infections have evolved substantially, with the development of novel assays as well as the availability of updated tests for emerging ones. Newer laboratory methods are fast, highly sensitive and specific, and are gradually replacing the conventional gold standards. This presentation reviews the current laboratory methods available for testing coronaviruses by focusing on the coronavirus disease 2019 (COVID-19) outbreak going on in Wuhan. Viral pneumonias typically do not result in the production of purulent sputum. Thus, a nasopharyngeal swab is usually the collection method used to obtain a specimen for testing. Nasopharyngeal specimens may miss some infections; a deeper specimen may need to be obtained by bronchoscopy. Alternatively, repeated testing can be used because over time, the likelihood of the SARS-CoV-2 being present in the nasopharynx increases. Several integrated, random-access, point-of-care molecular devices are currently under development for fast and accurate diagnosis of SARS-CoV-2 infections. These assays are simple, fast and safe and can be used in the local hospitals and clinics bearing the burden of identifying and treating patients.


Asunto(s)
Betacoronavirus , Técnicas de Laboratorio Clínico , Enfermedades Transmisibles Emergentes/diagnóstico , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Antígenos Virales/análisis , Betacoronavirus/genética , Betacoronavirus/inmunología , Enfermedades Transmisibles Emergentes/epidemiología , Enfermedades Transmisibles Emergentes/mortalidad , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/mortalidad , Brotes de Enfermedades , Humanos , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/mortalidad , Pruebas en el Punto de Atención , Reacción en Cadena en Tiempo Real de la Polimerasa , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Pruebas Serológicas , Síndrome Respiratorio Agudo Grave/diagnóstico , Síndrome Respiratorio Agudo Grave/epidemiología , Síndrome Respiratorio Agudo Grave/mortalidad , Manejo de Especímenes
8.
West J Emerg Med ; 21(2): 404-410, 2020 Feb 25.
Artículo en Inglés | MEDLINE | ID: mdl-32191198

RESUMEN

INTRODUCTION: Shortening emergency department (ED) visit time can reduce ED crowding, morbidity and mortality, and improve patient satisfaction. Point-of-care testing (POCT) has the potential to decrease laboratory turnaround time, possibly leading to shorter time to decision-making and ED length of stay (LOS). We aimed to determine whether the implementation of POCT could reduce time to decision-making and ED LOS. METHODS: We conducted a randomized control trial at the Urgency Room of Siriraj Hospital in Bangkok, Thailand. Patients triaged as level 3 or 4 were randomized to either the POCT or central laboratory testing (CLT) group. Primary outcomes were time to decision-making and ED LOS, which we compared using Mann-Whitney-Wilcoxon test. RESULTS: We enrolled a total of 248 patients: 124 in the POCT and 124 in the CLT group. The median time from arrival to decision was significantly shorter in the POCT group (106.5 minutes (interquartile [IQR] 78.3-140) vs 204.5 minutes (IQR 165-244), p <0.001). The median ED LOS of the POCT group was also shorter (240 minutes (IQR 161.3-410) vs 395.5 minutes (IQR 278.5-641.3), p <0.001). CONCLUSION: Using a point-of-care testing system could decrease time to decision-making and ED LOS, which could in turn reduce ED crowding.


Asunto(s)
Toma de Decisiones , Servicio de Urgencia en Hospital , Satisfacción del Paciente , Pruebas en el Punto de Atención , Tiempo de Tratamiento , Aglomeración , Femenino , Hospitales , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Sistemas de Atención de Punto , Tailandia , Factores de Tiempo , Triaje
11.
PLoS One ; 15(2): e0228687, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32012203

RESUMEN

INTRODUCTION: Point of care blood testing to aid diagnosis is becoming increasingly common in acute ambulatory settings and enables timely investigation of a range of diagnostic markers. However, this testing allows scope for errors in the pre-analytical phase, which depends on the operator handling and transferring specimens correctly. The extent and nature of these pre-analytical errors in clinical settings has not been widely reported. METHODS: We carried out a convergent parallel mixed-methods service evaluation to investigate pre-analytical errors leading to a machine error reports in a large acute hospital trust in the UK. The quantitative component comprised a retrospective analysis of all recorded error codes from Abbott Point of Care i-STAT 1, i-STAT Alinity and Abbott Rapid Diagnostics Afinion devices to summarise the error frequencies and reasons for error, focusing on those attributable to the operator. The qualitative component included a prospective ethnographic study and a secondary analysis of an existing ethnographic dataset, based in hospital-based ambulatory care and community ambulatory care respectively. RESULTS: The i-STAT had the highest usage (113,266 tests, January 2016-December 2018). As a percentage of all tests attempted, its device-recorded overall error rate was 6.8% (95% confidence interval 6.6% to 6.9%), and in the period when reliable data could be obtained, the operator-attributable error rate was 2.3% (2.2% to 2.4%). Staff identified that the most difficult step was the filling of cartridges, but that this could be improved through practice, with a perception that cartridge wastage through errors was rare. CONCLUSIONS: In the observed settings, the rate of errors attributable to operators of the primary point of care device was less than 1 in 40. In some cases, errors may lead to a small increase in resource use or time required so adequate staff training is necessary to prevent adverse impact on patient care.


Asunto(s)
Instituciones de Atención Ambulatoria , Análisis Químico de la Sangre/métodos , Errores Médicos , Pruebas en el Punto de Atención , Venas , Humanos
13.
Isr Med Assoc J ; 22(2): 94-99, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32043326

RESUMEN

BACKGROUND: Internal thoracic impedance (ITI) measurement is a sensitive method for detecting preclinical pulmonary edema and pleural effusion. OBJECTIVES: To investigate the efficacy of this non-invasive method for detecting early pleural effusion among geriatric patients and to monitor increased ITI during its resolution. METHODS: This prospective, controlled study was conducted between July 2012 and August 2015. The study comprised 70 patients aged 65 to 94 years; and 39 of the patients had pleural effusion. ITI was measured continuously with a RS-207 monitor. The predictive value of ITI monitoring was determined based on a total of eight measurements taken at 12-hour intervals over 84 hours. RESULTS: As a result of medical treatment, the median ITI of the study group increased from 31 (interquartile range [IQR] 28-33 ohms) to 41 ohms (IQR 38-41 ohms; P < 0.001) compared to non-significant changes in the control group. Average respiratory rate (per minute) in the study group decreased from 29 (IQR 28-34) to 19 (IQR 18-20). CONCLUSIONS: ITI monitoring is efficient for diagnosis and for ongoing clinical evaluation of the treatment of elderly patients with pleural effusion. Timely treatment may prevent serious complications of effusions avoiding extended hospitalization.


Asunto(s)
Pletismografía de Impedancia/métodos , Derrame Pleural , Anciano , Diagnóstico Precoz , Femenino , Evaluación Geriátrica/métodos , Humanos , Israel , Masculino , Monitoreo Fisiológico/métodos , Derrame Pleural/diagnóstico , Derrame Pleural/etiología , Derrame Pleural/fisiopatología , Pruebas en el Punto de Atención , Recurrencia , Reproducibilidad de los Resultados
15.
Br J Anaesth ; 124(3): 345-353, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31952649

RESUMEN

BACKGROUND: Bedside lung volume measurement could personalise ventilation and reduce driving pressure in patients with acute respiratory distress syndrome (ARDS). We investigated a modified gas-dilution method, the inspired sinewave technique (IST), to measure the effective lung volume (ELV) in pigs with uninjured lungs and in an ARDS model. METHODS: Anaesthetised mechanically ventilated pigs were studied before and after surfactant depletion by saline lavage. Changes in PEEP were used to change ELV. Paired measurements of absolute ELV were taken with IST (ELVIST) and compared with gold-standard measures (sulphur hexafluoride wash in/washout [ELVSF6] and computed tomography (CT) [ELVCT]). Measured volumes were used to calculate changes in ELV (ΔELV) between PEEP levels for each method (ΔELVIST, ΔELVSF6, and ΔELVCT). RESULTS: The coefficient of variation was <5% for repeated ELVIST measurements (n=13 pigs). There was a strong linear relationship between ELVIST and ELVSF6 in uninjured lungs (r2=0.97), and with both ELVSF6 and ELVCT in the ARDS model (r2=0.87 and 0.92, respectively). ELVIST had a mean bias of -12 to 13% (95% limits=±17 - 25%) compared with ELVSF6 and ELVCT. ΔELVIST was concordant with ΔELVSF6 and ΔELVCT in 98-100% of measurements, and had a mean bias of -73 to -77 ml (95% limits=±128 - 186 ml) compared with ΔELVSF6 and -1 ml (95% limits ±333 ml) compared with ΔELVCT. CONCLUSIONS: IST provides a repeatable measure of absolute ELV and shows minimal bias when tracking PEEP-induced changes in lung volume compared with CT in a saline-lavage model of ARDS.


Asunto(s)
Respiración con Presión Positiva/métodos , Síndrome de Dificultad Respiratoria del Adulto/terapia , Animales , Modelos Animales de Enfermedad , Mediciones del Volumen Pulmonar/métodos , Pruebas en el Punto de Atención , Reproducibilidad de los Resultados , Síndrome de Dificultad Respiratoria del Adulto/diagnóstico por imagen , Síndrome de Dificultad Respiratoria del Adulto/etiología , Síndrome de Dificultad Respiratoria del Adulto/fisiopatología , Solución Salina , Sus scrofa , Tomografía Computarizada por Rayos X
16.
Am J Trop Med Hyg ; 102(3): 562-566, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31971152

RESUMEN

Point-of-care urine-lipoarabinomannan (LAM) Alere Determine TB-LAM assay has shown utility diagnosing tuberculosis (TB) in HIV-positive, severely immunocompromised, TB-symptomatic patients. We assessed LAM results in severely immunocompromised patients, who had LAM systematically performed at new or follow-up HIV consultations. This was a prospective, observational study on consecutive ambulatory, > 15-year-old HIV-positive patients with CD4 < 100 cells/µL in Mozambique. Clinical assessments and LAM were performed for all and microscopy, Xpert, sputum culture, and chest X-ray for LAM-positive participants. Patients were followed up for 6 months. Of 360 patients, half were ART-naive. Lipoarabinomannan positivity was 11.9% (43/360), higher among symptomatic patients compared with asymptomatic: 18.5% (30/162), and 6.6% (13/198), respectively, P = 0.001. Tuberculosis was bacteriologically confirmed in 6/35 LAM-positive patients (2 of them asymptomatic). Lipoarabinomannan positivity was associated with higher risk of mortality (adjusted odds ratio [aOR]: 4.6, 95% CI: 1.3-15.6, P = 0.015). Systematic urine-LAM allows for rapid TB treatment initiation in severely immunocompromised HIV ambulatory patients and identifies patients at a higher risk of death.


Asunto(s)
Infecciones por VIH/complicaciones , Infecciones por VIH/patología , Lipopolisacáridos/orina , Pruebas en el Punto de Atención , Tuberculosis/diagnóstico , Urinálisis/métodos , Adulto , Femenino , Infecciones por VIH/orina , VIH-1 , Humanos , Huésped Inmunocomprometido , Masculino , Tuberculosis/complicaciones , Tuberculosis/orina
17.
Anesthesiology ; 132(2): 280-290, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31939843

RESUMEN

BACKGROUND: Concern remains over reliable point-of-care testing to guide reversal of rivaroxaban, a commonly used factor Xa inhibitor, in high-acuity settings. Thromboelastography (TEG), a point-of-care viscoelastic assay, may have the ability to detect the anticoagulant effect of rivaroxaban. The authors ascertained the association of apparent rivaroxaban concentration with thromboelastography reaction time, i.e., time elapsed from blood sample placement in analyzer until beginning of clot formation, as measured using TEG and TEG6S instruments (Haemonetics Corporation, USA), hypothesizing that reaction time would correlate to degree of functional factor Xa impairment. METHODS: The authors prospectively performed a diagnostic accuracy study comparing coagulation assays to apparent (i.e., indirectly assessed) rivaroxaban concentration in trauma patients with and without preinjury rivaroxaban presenting to a single center between April 2016 and July 2018. Blood samples at admission and after reversal or 24 h postadmission underwent TEG, TEG6S, thrombin generation assay, anti-factor Xa chromogenic assay, prothrombin time (PT), and ecarin chromogenic assay testing. The authors determined correlation of kaolin TEG, TEG6S, and prothrombin time to apparent rivaroxaban concentration. Receiver operating characteristic curve compared capacity to distinguish therapeutic rivaroxaban concentration (i.e., greater than or equal to 50 ng/ml) from nontherapeutic concentrations. RESULTS: Eighty rivaroxaban patients were compared to 20 controls. Significant strong correlations existed between rivaroxaban concentration and TEG reaction time (ρ = 0.67; P < 0.001), TEG6S reaction time (ρ = 0.68; P < 0.001), and prothrombin time (ρ = 0.73; P < 0.001), however reaction time remained within the defined normal range for the assay. Rivaroxaban concentration demonstrated strong but not significant association with coagulation assays postreversal (n = 9; TEG reaction time ρ = 0.62; P = 0.101; TEG6S reaction time ρ = 0.57; P = 0.112) and small nonsignificant association for controls (TEG reaction time: ρ = -0.04; P = 0.845; TEG6S reaction time: ρ = -0.09; P = 0.667; PT-neoplastine: ρ = 0.19; P = 0.301). Rivaroxaban concentration (area under the curve, 0.91) and TEG6S reaction time (area under the curve, 0.84) best predicted therapeutic rivaroxaban concentration and exhibited similar receiver operating characteristic curves (P = 0.180). CONCLUSIONS: Although TEG6S demonstrates significant strong correlation with rivaroxaban concentration, values within normal range limit clinical utility rendering rivaroxaban concentration the gold standard in measuring anticoagulant effect.


Asunto(s)
Inhibidores del Factor Xa/administración & dosificación , Pruebas en el Punto de Atención/normas , Rivaroxabán/administración & dosificación , Tromboelastografía/normas , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Relación Dosis-Respuesta a Droga , Inhibidores del Factor Xa/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas en el Punto de Atención/tendencias , Estudios Prospectivos , Rivaroxabán/sangre , Tromboelastografía/tendencias
18.
Ann Otol Rhinol Laryngol ; 129(1): 39-45, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31416326

RESUMEN

BACKGROUND: Olfactory dysfunction is an important facet of numerous disease states ranging from sinonasal disease to neurocognitive disorders. Due to expense and/or logistical barriers, objective olfactory testing is not common. We describe the creation of a novel, essential oil-based smell test, Affordable Rapid Olfaction Measurement Array (AROMA), composed at 14 scents at different concentrations and demonstrate correlation of AROMA with the University of Pennsylvania Smell Identification Test (UPSIT), patient age, Sinonasal Outcomes Test (SNOT-22), and perceived loss of smell. METHODS: AROMA was developed for point-of-care olfactory testing and compared to the UPSIT, as well as subjective outcome measures as noted above. About 37 healthy controls were prospectively recruited to assess the reliability of AROMA using a test-retest protocol. An additional cohort of 38 participants with sinonasal disease were prospectively recruited to complete the AROMA and UPSIT, and were compared with a cohort of 30 healthy controls. Spearman correlation correlated AROMA and UPSIT results, patient age, SNOT-22, and perceived loss of smell. RESULTS: AROMA demonstrated good test-retest reliability (r = 0.85, P < .001). Spearman's rho correlation of AROMA to UPSIT was statistically significant at ρ = 0.75 (P < .001). SNOT-22, age, and perceived sense of smell were all significantly correlated with both AROMA (ρ = -0.548, -0.557, -0.642, respectively) and UPSIT (ρ = -0.367, -0.460, -0.552, respectively). CONCLUSION: AROMA has a strong correlation with UPSIT and may be more strongly correlated with sinonasal outcomes. Additionally, AROMA is reusable; level of odorant is not static; and AROMA can test both odor detection and identification. LEVEL OF EVIDENCE: 2b.


Asunto(s)
Odorantes , Aceites Volátiles , Trastornos del Olfato/diagnóstico , Adulto , Estudios de Casos y Controles , Técnicas y Procedimientos Diagnósticos/economía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas en el Punto de Atención , Umbral Sensorial , Prueba de Resultado Sino-Nasal
19.
Anaesthesia ; 75(3): 366-373, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31845321

RESUMEN

Coagulopathic bleeding during and after cardiac surgery is associated with increased morbidity and mortality. Viscoelastic testing is increasingly used instead of laboratory testing. Our aim was to compare a new viscoelastic point-of-care device, the Quantra® System, with thromboelastography and standard laboratory testing. After ethical approval and with written informed consent, we prospectively recruited adult patients undergoing urgent cardiac surgery at increased risk of bleeding. Clot time and clot stiffness values were compared before, during and after cardiopulmonary bypass. We prospectively recruited 52 patients, of whom 34 (65%) were transfused with red blood cells. Our usual transfusion thresholds for fibrinogen (1.5 g.l-1 ), platelets (100,000.µl-1 ), prothrombin time (20 s), activated partial thromboplastin time (48 s) and maximum amplitude on thromboelastography (50 mm) corresponded to Quantra values of fibrinogen clot stiffness 2.0 hPa, platelet clot stiffness 13.5 hPa, clot time 159 s, clot time 183 s and clot stiffness 17.0 hPa, respectively. These Quantra thresholds showed high negative predictive value for low platelets (platelet clot stiffness, 97.4%), prolonged activated partial thromboplastin time (clot time, 92.6%) and reduced maximum amplitude on thromboelastography (clot stiffness, 93.6%). The Quantra predicted clinical need for transfusion of platelets (area under the curve 0.71, p = 0.001) but all tests performed poorly at predicting the need for fresh frozen plasma transfusion. We have shown that point-of-care testing using the novel Quantra system provides useful data for guiding transfusion management.


Asunto(s)
Transfusión Sanguínea/instrumentación , Procedimientos Quirúrgicos Cardíacos/métodos , Hemostasis , Pruebas en el Punto de Atención , Tromboelastografía/métodos , Anciano , Anciano de 80 o más Años , Pruebas de Coagulación Sanguínea , Viscosidad Sanguínea , Estudios de Cohortes , Elasticidad , Servicios Médicos de Urgencia , Transfusión de Eritrocitos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Plasma , Transfusión de Plaquetas , Valor Predictivo de las Pruebas , Estudios Prospectivos
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