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Point of care coagulometry in prehospital emergency care: an observational study

Beynon, Christopher ; Erk, Angelina G. ; Potzy, Anna ; Mohr, Stefan ; Popp, Erik

In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 23 (2015), Nr. 58. pp. 1-6. ISSN 1757-7241

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Abstract

Background: Haemostatic impairment can have a crucial impact on the outcome of emergency patients, especially in cases of concomitant antithrombotic drug treatment. In this prospective observational study we used a point of care (POC) coagulometer in a prehospital physician-based emergency medical system in order to test its validity and potential value in the treatment of emergency patients. Methods: During a study period of 12 months, patients could be included if venous access was mandatory for further treatment. The POC device CoaguChek® was used to assess international normalized ratio (INR) after ambulance arrival at the scene. Results were compared with in-hospital central laboratory assessment of INR. The gain of time was analysed as well as the potential value of POC testing through a questionnaire completed by the responsible prehospital emergency physician. Results: A total of 103 patients were included in this study. POC INR results were highly correlated with results of conventional assessment of INR (Bland-Altman-bias: 0.014). Using a cutoff value of INR >1.3, the device’s sensitivity to detect coagulopathy was 100 % with a specificity of 98.7 %. The median gain of time was 69 min. Treating emergency physicians considered the value of prehospital POC INR testing ‘high’ in 9 % and ‘medium’ in 21 % of all patients. In patients with tracer diagnosis ‘neurology’, the value of prehospital INR assessment was considered ‘high’ or ‘medium’ (63 %) significantly more often than in patients with non-neurological tracer diagnoses (24 %). Conclusions: Assessment of INR through a POC coagulometer is feasible in prehospital emergency care and provides valuable information on haemostatic parameters in patients. Questionnaire results suggest that POC INR testing may present a valuable technique in selected patients. Whether this information translates into an improved management of respective patients has to be evaluated in further studies.

Item Type: Article
Journal or Publication Title: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Volume: 23
Number: 58
Publisher: BioMed Central
Place of Publication: London
Date Deposited: 22 Dec 2015 09:30
Date: 2015
ISSN: 1757-7241
Page Range: pp. 1-6
Faculties / Institutes: Medizinische Fakultät Heidelberg > Universitätsklinik für Anaesthesiologie
Medizinische Fakultät Heidelberg > Neurochirurgische Universitätsklinik
Subjects: 610 Medical sciences Medicine
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