Current Status of Point-of-Care Testing in Clinical Toxicology: Focus on Drugs of Abuse

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Abstract

Point-of-care testing (POCT) or near-patient testing is rapidly growing and expanding to cover different areas of diagnostic tests. The main objective of POCT is to assure rapid delivery of the results for clinical management of the patients. In theory, this can lead to improved clinical and economical outcome of patient health care.

In clinical toxicology, laboratory tests are performed using very sophisticated and costly instruments that have to be operated by highly qualified personnel. Usually, the process is time-consuming and involves multiple steps.

A number of point-of-care assays for clinical and forensic toxicology have been developed by different manufacturers. Point-of-care testing devices have been designed for single- or multiple-drug detection. The selection of detected drugs should be based on patient demographics and the intended application. Point-of-care testing devices typically use immunochromatographic methods and mostly they permit visually read results. The packaging formats range from dipsticks to cup devices, cards, or plastic cassettes. Urine is the specimen of choice for most of the devices, although assays for other biological samples are available. With some devices, the testing is performed in 1 step after depositing the sample in the collection container, whereas other devices require multiple steps.

Proper use of these devices requires careful evaluation and comparison to established laboratory methods. Different factors have to be considered carefully before implementing POCT for clinical toxicology. These factors include turnaround time, instrument maintenance including calibration and controls, operator training, competency, results interpretation, results reporting, and cost.

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