Point-of-Care Tests' Role in Time Metrics of Urgent Interventions in Emergency Department; a Systematic Review of Literature

Sara Rahsepar; Mohammad Sadegh Sanie Jahromi; Samaneh Abiri; Reza Akhavan; Hossein Akhavan; Bita Abbasi; Fatemeh Maleki; Somayyeh Ahmadnezhad; Behrang Rezvani Kakhki; Navid Kalani; Pourya Adibi

doi:10.22037/aaem.v10i1.1817

Point-of-Care Tests' Role in Time Metrics of Urgent Interventions in Emergency Department; a Systematic Review of Literature

Arch Acad Emerg Med. 2022 Oct 10;10(1):e82. doi: 10.22037/aaem.v10i1.1817. eCollection 2022.

Authors

Affiliations

¹ Department of Dermatology, Mashhad University of Medical sciences, Mashhad, Iran.
² Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran.
³ Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran.
⁴ Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
⁵ Department of Radiology, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran.
⁶ Department of Emergency Medicine, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran.
⁷ Department of Emergency Medicine, Ramsar Campus, Mazandaran University of Medical Sciences, Ramsar, Iran.
⁸ Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran.
⁹ Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.

Abstract

Introduction: Point-of-Care Testing (POCT) could be helpful in clinical decisions, treatment selection, monitoring, prognostication, operational decision-making, and resource utilization. This study aimed to review the role of POCT in time metrics of performing urgent interventions in the emergency department (ED) or disposition time to proper care.

Methods: This was a systematic review of the literature based on the PRISMA statement. PubMed, Scopus, Web of Science, and EMBASE databases were searched for studies reporting the application of the POCT in the ED with outcomes of the time to intervention or disposition.

Results: After reviewing 3708 articles, 16 studies with 100,224 participants were included in this systematic review. There were 5 randomized clinical trials (RCTs), 5 retrospective cohorts, 2 prospective cohorts, and 4 before-after studies. All studies were performed in an ED setting except for one study of prehospital EMS air medical transport. Different panels, ultrasound, cardiac parameters, echocardiography, and polymerase chain reaction (PCR) POCTs were used in the studies. Regarding the outcome measures, studies with many types of patients referring to ED used different indices of time to intervention or time to disposition. Studies on different shock circumstances used the time to the first bolus of hydration or vasopressor or intravenous antibiotics for septic shock patients and central venous catheterization (CVC) placement time in one study. Time to imaging was considered as the outcome in some studies. Overall, there was a high risk of bias, especially in case of the randomization methods, and non-blinded designs in RCTs. There was lower possibility of bias in non-randomized studies but the studies did not have enough follow-ups and in case of studies using advanced panels of POCT, results do not seem to be easily applicable to public health care in many countries.

Conclusion: In synthesis of the evidence, all included studies were reporting the benefits of the POCT in decreasing the time to proper interventions and increasing the time to negative interventions in the last lines of critical care as well as the intubation and CVC placement.

Keywords: Emergency medicine; emergency treatment; point-of-care systems; point-of-care testing.

Publication types

Review