Point-of-care prothrombin time testing in paediatric intensive care: an observational study of the ease of use of two devices

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BackgroundTwo major difficulties arise when taking blood samples in children: the challenge of venous access and the comparatively large amount of blood required.ObjectiveTo assess the value of point-of-care prothrombin time testing in paediatric intensive care patients. We evaluated two point-of-care devices, CoaguChek XS Plus and CoaLine, assessing ease of use in clinical practice and correlation with the standard prothrombin time measurement of the haematology laboratory.DesignSingle-centre observational study.SettingBetween October 2007 and March 2008, patients in an interdisciplinary paediatric ICU of a tertiary centre were analysed.Patients or other participantsThirty-eight patients, 22 female and 16 male (58 and 42%), aged between 0 and 13 years, participated in the study. The intention was to evaluate the ease of use of the devices in daily clinical practice, and no exclusion criteria were applied.Main outcome measuresThe usefulness of the two point-of-care devices in the paediatric setting was evaluated. Measurements of point-of-care and standard laboratory prothrombin time were compared in terms of agreement and correlation.ResultsCoaguChek XS Plus had a failure rate of 2%, CoaLine 17% and the laboratory standard 4%. CoaguChek XS Plus received a better ease of use rating than CoaLine by the study personnel. Compared with the laboratory standard, there was considerable variability of the observed measurements with both devices. The measurements of CoaguChek XS Plus and the standard had a correlation coefficient r of being 0.79. CoaLine and the standard had a correlation coefficient r value of 0.72.ConclusionCoaguChek XS Plus showed ‘good’ agreement, whereas CoaLine showed ‘moderate’ agreement compared with prothrombin time values using the standard method. The fast availability of results and the reduction of the required blood volume are advantages of point-of-care tests in the paediatric setting.

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