Value of point-of-care blood testing in emergent trauma management

Background: No prospective study demonstrates the value of point-of-care la boratory testing (POCT) in the management of major trauma, Methods: In a prospective, noninterventional, study of 200 major trauma pat ients, we evaluated the influence of a blood POCT profile (hemoglobin, Na+, K+, Cl-, blood urea nitrogen, glucose, pH, P-CO2, P-O2, H-CO3(-), base def icit, and lactate) on emergent diagnostic and therapeutic interventions. Ph ysicians responded to a standardized set of questions on their diagnostic a nd therapeutic plans before and after the availability of POCT results. Man agement plan changes were deemed emergently appropriate, if they were influ enced by the POCT results and, within the ensuing 30 minutes, the change in management was likely to reduce morbidity or conserve resources, Results: For emergently appropriate plan changes, Na+, Cl-, K+, and blood u rea nitrogen were never influential, whereas in each of 6.0% of cases (95% confidence interval [CII, 3.5%-10.2%) at least one of the remaining POCT pa rameters was influential. An emergently appropriate change was based on hem oglobin in 3.5% of cases (95% CI, 1.0%-6.1%), blood gas parameters in 3.0% of cases (95% CI, 0.64%-5.7%), lactate in 2.5% of cases (95% CI, 1.1%-5.7%) , and glucose in 0.5% of cases (95% CI, 0.1%-2.8%). All of these cases invo lved blunt injury. Conclusion: Na+, Cl-, K+, and blood urea nitrogen levels do not influence t he initial management of major trauma patients. In patients with severe blu nt injury, hemoglobin, glucose, blood gas, and lactate measurements occasio nally result in morbidity-reducing or resource-conserving management change s.