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The usefulness of rapid point-of-care creatinine testing for the prevention of contrast-induced nephropathy in the emergency department
  1. Je Sung You1,
  2. Yong Eun Chung2,
  3. Jong Woo Park3,
  4. Woonhyoung Lee4,
  5. Hye-Jeong Lee2,
  6. Tae Nyoung Chung5,
  7. Sung Phil Chung1,
  8. Incheol Park1,
  9. Seungho Kim1
  1. 1Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
  2. 2Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
  3. 3Department of Emergency Medicine, Changwon Fatima Hospital, Changwon, Seoul, Republic of Korea
  4. 4Department of Emergency Medicine, Changwon Fatima Hospital, Changwon-Si, Kyoungsangnam-Do Republic of Korea
  5. 5Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-Si, Gyoenggi-Do, Republic of Korea
  1. Correspondence to Dr Incheol Park, Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Gu, Seoul 135-720, Republic of Korea; incheol{at}yuhs.ac

Abstract

Background Renal dysfunction is the most important factor to consider when predicting a patient's risk of developing contrast-induced nephropathy (CIN). Measurement of creatinine (Cr) via rapid point-of-care blood urea nitrogen/creatinine testing (POCT-BUN/Cr) to determine CIN risk could potentially reduce the time required to achieve an accurate diagnosis and to initiate and complete treatment in the emergency department (ED). The aim of our study was to compare the results of POCT-BUN/Cr and reference laboratory tests for BUN and serum Cr.

Materials and methods A retrospective analysis of suspected stroke patients who presented between November 2009 and November 2010, and had BUN and Cr levels measured by POCT-BUN/Cr, and the reference laboratory tests performed with the blood sample which was transferred to the central laboratory by an air-shoot system. Two assays were conducted on the whole blood (POCT) and serum (reference) by trained technicians. The time interval from arrival at the ED to reporting of the results was assessed for both assays via a computerised physician order entry system.

Results The mean standard deviation (SD) interval from arrival at the ED to reporting of the results was 11.4 (4.9) min for POCT-BUN/Cr and 46.8 (38.5) min for the serum reference laboratory tests (p<0.001). Intra-class correlation coefficient (ICC) analysis demonstrated a high level of agreement (the consistency agreement) between POCT and the serum reference tests for both BUN (ICC=0.914) and Cr (ICC=0.980).

Conclusions This study suggests that POCT-BUN/Cr results correlate well with those of serum reference tests in terms of BUN and Cr levels and, in turn, predicting CIN. POCT-BUN/Cr is easily performed with a rapid turnaround time, suggesting its use in the ED may have substantial clinical benefit.

  • Computed tomography
  • point-of-care testing
  • contrast-induced nephropathy
  • creatinine

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Footnotes

  • Competing interests None.

  • Ethics approval Ethics approval was provided by Yonsei University College of Medicine, Severance Hospital IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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