The accuracy and timeliness of a Point Of Care lactate measurement in patients with Sepsis

BACKGROUND: The aims of this study were to a) compare the lactate measurement of a Point of Care (POC) handheld device to near patient blood gas analysers, and b) determine the differential reporting times between the analysers. METHODS: A two-staged study; method comparison and prospective observational stages, was conducted. For the first stage, blood samples were analysed on the i-STAT handheld device and the near patient blood gas analysers (GEM 4000 and OMNI S). Results were compared using Pearson correlation coefficient and Bland-Altman tests. For the second stage, we examined the differential reporting times of the POC device compared to the near patient blood gas analysers in two Scottish hospitals. Differential reporting times were assessed using Mann–Whitney test and descriptive statistics were reported with quartiles. RESULTS: Highly significant Pearson correlation coefficients (0.999 and 0.993 respectively) were found between i-STAT and GEM 4000 and OMNI S. The Bland-Altman agreement method showed bias values of −0.03 and −0.24, between i-STAT and GEM 4000 and OMNI S respectively. Median time from blood draw to i-STAT lactate results was 5 min (Q1–Q3 5–7). Median time from blood draw to GEM 4000 lactate results was 10 min (Q1–Q3 7.75–13). Median time from blood draw to OMNIS lactate results was 11 min (Q1–Q3 8–22). The i-STAT was significantly quicker than both the GEM 4000 and the OMNIS (each p-value < 0.001). In addition, 18 of our study samples were sent to the central laboratory for analysis due to a defect in the lactate module of OMNI S. The median time for these samples from blood draw to availability of the central laboratory results at the clinical area was 133 min. CONCLUSIONS: The POC handheld device produced accurate, efficient and timely lactate measurements with the potential to influence clinical decision making sooner

Non-contact infrared versus axillary and tympanic thermometers in children attending primary care:a mixed-methods study of accuracy and acceptability

Background: Guidelines recommend the measurement of temperature in children presenting with fever symptoms using electronic axillary, or tympanic thermometers. Non-contact thermometry offers advantages yet have not been tested against the recommended methods in primary care. Aim: To compare two different non-contact infrared thermometers (NCITs) to axillary and tympanic thermometers in children aged 5 or under attending their GP with an acute illness. Design and setting: Prospective design in primary care. Method: Methods comparison study with nested qualitative component. Results: 401 children were recruited (median age 1.6 years, 50.62% boys). The mean difference between the Thermofocus NCIT and axillary thermometer was -0.14°C (95% CI -0.21 to -0.06); the lower limit of agreement was -1.57°C (95% CI -1.69 to -1.44) and the upper limit 1.29°C (95% CI 1.16 to 1.42). A second NCIT (Firhealth) had similar levels of agreement. However, the limits of agreement between tympanic and axillary thermometers were also wide. Parents expressed a preference for the practicality and comfort afforded by NCITs, and were predominantly negative about their child’s experience of axillary thermometers. However, there was a willingness to adopt whichever device was medically recommended. Conclusions In a primary care paediatric population, temperature measurements with NCITs varied by over a degree Celsius compared to axillary and tympanic approaches. However, there was also poor agreement between tympanic and axillary thermometers. Since clinical guidelines often rely on specific fever thresholds, clinicians should interpret peripheral thermometer readings with caution, and in the context of an holistic assessment of the child.</p

Non-contact infrared thermometers compared with current approaches in primary care for children aged 5 years and under: a method comparison study

Background: Current options for temperature measurement in children presenting to primary care include either electronic axillary or infrared tympanic thermometers. Non-contact infrared thermometers could reduce both the distress of the child and the risk of cross-infection. Objectives: The objective of this study was to compare the use of non-contact thermometers with the use of electronic axillary and infrared tympanic thermometers in children presenting to primary care. Design: Method comparison study with a nested qualitative study. Setting: Primary care in Oxfordshire. Participants: Children aged Interventions: Two types of non-contact infrared thermometers [i.e. Thermofocus (Tecnimed, Varese, Italy) and Firhealth (Firhealth, Shenzhen, China)] were compared with an electronic axillary thermometer and an infrared tympanic thermometer. Main outcome measures: The primary outcome was agreement between the Thermofocus non-contact infrared thermometer and the axillary thermometer. Secondary outcomes included agreement between all other sets of thermometers, diagnostic accuracy for detecting fever, parental and child ratings of acceptability and discomfort, and themes arising from our qualitative interviews with parents. Results: A total of 401 children (203 boys) were recruited, with a median age of 1.6 years (interquartile range 0.79-3.38 years). The readings of the Thermofocus non-contact infrared thermometer differed from those of the axillary thermometer by -0.14 degrees C (95% confidence interval -0.21 to -0.06 degrees C) on average with the lower limit of agreement being -1.57 degrees C (95% confidence interval -1.69 to -1.44 degrees C) and the upper limit being 1.29 degrees C (95% confidence interval 1.16 to 1.42 degrees C). The readings of the Firhealth non-contact infrared thermometer differed from those of the axillary thermometer by -0.16 degrees C (95% confidence interval -0.23 to -0.09 degrees C) on average, with the lower limit of agreement being -1.54 degrees C (95% confidence interval -1.66 to -1.41 degrees C) and the upper limit being 1.22 degrees C (95% confidence interval 1.10 to 1.34 degrees C). The difference between the first and second readings of the Thermofocus was -0.04 degrees C (95% confidence interval -0.07 to -0.01 degrees C); the lower limit was -0.56 degrees C (95% confidence interval -0.60 to -0.51 degrees C) and the upper limit was 0.47 degrees C (95% confidence interval 0.43 to 0.52 degrees C). The difference between the first and second readings of the Firhealth thermometer was 0.01 degrees C (95% confidence interval - 0.02 to 0.04 degrees C); the lower limit was -0.60 degrees C (95% confidence interval -0.65 to -0.54 degrees C) and the upper limit was 0.61 degrees C (95% confidence interval 0.56 to 0.67 degrees C). Sensitivity and specificity for the Thermofocus non-contact infrared thermometer were 66.7% (95% confidence interval 38.4% to 88.2%) and 98.0% (95% confidence interval 96.0% to 99.2%), respectively. For the Firhealth non-contact infrared thermometer, sensitivity was 12.5% (95% confidence interval 1.6% to 38.3%) and specificity was 99.4% (95% confidence interval 98.0% to 99.9%). The majority of parents found all methods to be acceptable, although discomfort ratings were highest for the axillary thermometer. The non-contact thermometers required fewer readings than the comparator thermometers. Limitations: A method comparison study does not compare new methods against a reference standard, which in this case would be central thermometry requiring the placement of a central line, which is not feasible or acceptable in primary care. Electronic axillary and infrared tympanic thermometers have been found to have moderate agreement themselves with central temperature measurements. Conclusions: The 95% limits of agreement are > 1 degrees C for both non-contact infrared thermometers compared with electronic axillary and infrared tympanic thermometers, which could affect clinical decision-making. Sensitivity for fever was low to moderate for both non-contact thermometers. Future work: Better methods for peripheral temperature measurement that agree well with central thermometry are needed

Non-contact infrared thermometers compared with current approaches in primary care for children aged 5 years and under: a method comparison study

BACKGROUND: Current options for temperature measurement in children presenting to primary care include either electronic axillary or infrared tympanic thermometers. Non-contact infrared thermometers could reduce both the distress of the child and the risk of cross-infection. OBJECTIVES: The objective of this study was to compare the use of non-contact thermometers with the use of electronic axillary and infrared tympanic thermometers in children presenting to primary care. DESIGN: Method comparison study with a nested qualitative study. SETTING: Primary care in Oxfordshire. PARTICIPANTS: Children aged ≤ 5 years attending with an acute illness. INTERVENTIONS: Two types of non-contact infrared thermometers [i.e. Thermofocus (Tecnimed, Varese, Italy) and Firhealth (Firhealth, Shenzhen, China)] were compared with an electronic axillary thermometer and an infrared tympanic thermometer. MAIN OUTCOME MEASURES: The primary outcome was agreement between the Thermofocus non-contact infrared thermometer and the axillary thermometer. Secondary outcomes included agreement between all other sets of thermometers, diagnostic accuracy for detecting fever, parental and child ratings of acceptability and discomfort, and themes arising from our qualitative interviews with parents. RESULTS: A total of 401 children (203 boys) were recruited, with a median age of 1.6 years (interquartile range 0.79-3.38 years). The readings of the Thermofocus non-contact infrared thermometer differed from those of the axillary thermometer by -0.14 °C (95% confidence interval -0.21 to -0.06 °C) on average with the lower limit of agreement being -1.57 °C (95% confidence interval -1.69 to -1.44 °C) and the upper limit being 1.29 °C (95% confidence interval 1.16 to 1.42 °C). The readings of the Firhealth non-contact infrared thermometer differed from those of the axillary thermometer by -0.16 °C (95% confidence interval -0.23 to -0.09 °C) on average, with the lower limit of agreement being -1.54 °C (95% confidence interval -1.66 to -1.41 °C) and the upper limit being 1.22 °C (95% confidence interval 1.10 to 1.34 °C). The difference between the first and second readings of the Thermofocus was -0.04 °C (95% confidence interval -0.07 to -0.01 °C); the lower limit was -0.56 °C (95% confidence interval -0.60 to -0.51 °C) and the upper limit was 0.47 °C (95% confidence interval 0.43 to 0.52 °C). The difference between the first and second readings of the Firhealth thermometer was 0.01 °C (95% confidence interval -0.02 to 0.04 °C); the lower limit was -0.60 °C (95% confidence interval -0.65 to -0.54 °C) and the upper limit was 0.61 °C (95% confidence interval 0.56 to 0.67 °C). Sensitivity and specificity for the Thermofocus non-contact infrared thermometer were 66.7% (95% confidence interval 38.4% to 88.2%) and 98.0% (95% confidence interval 96.0% to 99.2%), respectively. For the Firhealth non-contact infrared thermometer, sensitivity was 12.5% (95% confidence interval 1.6% to 38.3%) and specificity was 99.4% (95% confidence interval 98.0% to 99.9%). The majority of parents found all methods to be acceptable, although discomfort ratings were highest for the axillary thermometer. The non-contact thermometers required fewer readings than the comparator thermometers. LIMITATIONS: A method comparison study does not compare new methods against a reference standard, which in this case would be central thermometry requiring the placement of a central line, which is not feasible or acceptable in primary care. Electronic axillary and infrared tympanic thermometers have been found to have moderate agreement themselves with central temperature measurements. CONCLUSIONS: The 95% limits of agreement are > 1 °C for both non-contact infrared thermometers compared with electronic axillary and infrared tympanic thermometers, which could affect clinical decision-making. Sensitivity for fever was low to moderate for both non-contact thermometers. FUTURE WORK: Better methods for peripheral temperature measurement that agree well with central thermometry are needed. TRIAL REGISTRATION: Current Controlled Trials ISRCTN15413321. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 53. See the NIHR Journals Library website for further project information.status: publishe