Performance of point-of-care diagnostics for glucose, lactate, and hemoglobin in the management of severe malaria in a resource-constrained hospital in Uganda

Am J Trop Med Hyg. 2014 Apr;90(4):605-8. doi: 10.4269/ajtmh.13-0689. Epub 2014 Mar 3.

Abstract

Severe malaria is frequently managed without access to laboratory testing. We report on the performance of point-of-care tests used to guide the management of a cohort of 179 children with severe malaria in a resource-limited Ugandan hospital. Correlation coefficients between paired measurements for glucose (i-STAT and One Touch Ultra), lactate (i-STAT and Lactate Scout), and hemoglobin (Hb; laboratory and i-STAT) were 0.86, 0.85, and 0.73, respectively. The OneTouch Ultra glucometer readings deviated systematically from the i-STAT values by +1.7 mmol/L. Lactate Scout values were systematically higher than i-STAT by +0.86 mmol/L. Lactate measurements from either device predicted subsequent mortality. Hb estimation by the i-STAT instrument was unbiased, with upper and lower limits of agreement of -34 and +34 g/L, and it was 91% sensitive and 89% specific for the diagnosis of severe anemia (Hb < 50 g/L). New commercially available bedside diagnostic tools, although imperfect, may expedite clinical decision-making in the management of critically ill children in resource-constrained settings.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anemia / complications
  • Anemia / diagnosis*
  • Blood Glucose / analysis*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • Health Resources
  • Hemoglobin A / analysis*
  • Hospitals
  • Humans
  • Hypoglycemia / complications
  • Hypoglycemia / diagnosis*
  • Infant
  • Lactic Acid / blood*
  • Malaria / blood*
  • Malaria / complications
  • Male
  • Point-of-Care Systems / standards*
  • Sensitivity and Specificity
  • Uganda

Substances

  • Blood Glucose
  • Lactic Acid
  • Hemoglobin A