Point of care testing in your pediatric OPD practice, IAP Chandigarh Annual meet - Dec 2016

1. POCT in your OPD
Dr Gaurav Gupta
18th Dec 2016

2. Whats in it for YOU?
• What is POCT ?
• Do I really need POCT ?
• What tests can be done, ARE being done ?
• Possible problems ?

3. What I will not be doing
• Talking about individual tests
• Discussing larger analyzers
• Discussing other settings

6. 6
Patient Visit Analysis in lab Feedback to
patient. after 1-2
days by re-visit,
phone call or letter
Lab has long Turn Around Time
Specimen taken,
vial labelled and
sent to lab
Results
reported from
laboratory to
the doctors
office

7. 7
Patient Visit Analysis in lab Feedback to
patient. after 1-2
days by re-visit,
phone call or letter
Patient Visit Patient tested at the POC
Analysis of samples in the lab
Point of Care Testing
Specimen taken,
vial labelled and
sent to lab
Direct feed back to patient
provides opportunity for timely
treatment
Results reported
from laboratory
to the doctors
office

8. 8
Patient Visit Analysis in lab Feedback to
patient. after 1-2
days by re-visit,
phone call or letter
Patient Visit Patient tested at the POC
Analysis of samples in the lab
Point of Care Testing
Specimen taken,
vial labelled and
sent to lab
Results
reported
from lab to
doctor
Direct feed back to patient
provides opportunity for timely
treatment
With Point of Care Testing:
• Patient will get faster feedback, diagnose and timely treatment
• More Patients can be checked, diagnosed and treated due to less
paperwork and administration

9. What is POCT ?
Medical diagnostic testing
• performed outside the clinical laboratory
• close to the patient receiving care
• typically by non-laboratory personnel
• used for immediate clinical decision making
• no sample preparation
• ready to use reagents –’dry lab’
• Single sample equipment

10. ASSURED criteria by WHO
A = affordable
S = sensitive
S = specific
U = user friendly (simple to perform in a few
steps with minimal training)
R = robust and rapid (results available in less than
30 minutes)
E = equipment free
D = deliverable to those who need the test

11. ASSURED criteria by WHO
A = affordable
S = sensitive
S = specific
U = user friendly (simple to perform in a few
steps with minimal training)
R = robust and rapid (results available in less than
30 minutes)
E = equipment free
D = deliverable to those who need the test

12. POCT Rapid test
• Tests, by themselves, cannot be called POCT
• It is how the tests are deployed that makes
them POCT tests
– An RDT or dipstick in a reference lab is not
POCT
– BUT a molecular test in a clinic can be POCT!
• So, there are no POC tests, only POC testing.

13. Selected aspect of Point-of-Care testing- POCT:
• Hematology ( Hb, WBC Differential count)
• Blood gases, acid base equilibrium and electrolytes
• Glucose, HbA1c, Urine Albumin
• Clinical chemistry (creatinine, urea, GOT, GPT, etc.; dry
chemistry, ion-specific electrodes)
• CRP
• Lipid metabolism
• Bilirubin
• Hemostaseology (INR, PTT and ACT in whole blood.)
• Cardiovascular diagnostic testing (cardiac troponins, BNP and
D-dimers)
13Reference: Point-of-Care Testing in Hospitals and Primary Care; Dtsch Arztebl Int 2010; 107(33): 561–7

14. Hb Testing

15. WBC Diff

16. • AMR kills >700,000 people globally
• Without action 10 million people will die every year by 2050
Reference: The review on antimicrobial resistance, January
2016
Global Threat of Antimicrobial Resistance
16
6

17. Indian Academy of Pediatric
17

18. • Bacterial infection → increase in WBC
- Antibiotics are effective
• Viral infection → low or normal WBC
- No effect of antibiotics
• Bacterial and viral infections can cause
similar symptoms.
• Only bacterial infections can be
cured by antibiotics.
• Over prescription of antibiotics is a
major concern leading to antibiotic
resistance,
>50% considered unnecessary.
Can a WBC result guide decisions on when to
prescribe antibiotics?
18

19. • Fever of unknown source is the number one reason
for children to seek ER & Primary Care.
• Parental anxiety is common with young children.
• 20-40% of parents seek medical assessment
when their child develops a fever.
Pediatric Patients -WBC Screening
19

20. WBC Diff

22. “By adding a point-of-care WBC count as a part
of the clinical investigation, the prescription of
antibiotics in a pediatric setting could be
significantly reduced (77%).”
Cioffi et al, Global pediatric Health, Volume 3: 1-6, 2016
Decreased antibiotic prescription in an Italian pediatric population with nonspecific and persistent upper respiratory
tract infections by use of a point-of-care white blood cell count, in addition to antibiotic delayed prescription strategy.
Decreased antibiotic prescription by
adding point of care WBC count
22

23. Frequently Asked Questions (FAQ’s)
23
Q.I have easy access to lab and satisfied with the services and quality, so
any additional testing is not required.
Ans: There are few things that differentiate Point of Care testing from Lab:
• Patient convenience
• Its difficult to find vein of a child and its painful
• Patient may not turn up.
• Test is done in your site and any false test report can be avoided
Q. How am I assured about quality of this device and rely on reports?
Ans: Hemocue WBC diff has been evaluated by NASA against Beckman Coulter
LH750 cell counter and results are more than 99% accurate. Similar
evaluations have been done by KGMU, Lucknow; PGI Rohtak; Govt Rajaji Hosp.
Madurai against cell counters and manual testing method and results are more
than 99% accurate.

24. Frequently Asked Questions (FAQ’s)
24
Q. I’m not willing to perform test at my clinic as it is painful for
the patient.
Ans: Performing WBC through capillary sampling on finger
or heel stick involves negligible discomfort. Doing
vaccination is more painful than WBC diff test.
Q. I don’t have additional staff who can perform this test?
Ans: No additional trained technician is required, tests are
simple and easy to perform.

25. Urine Dipstick
• Pregnancy
• UTI
• Drugs of abuse

26. Strep A testing

28. Card tests

29. Pros of POCT
• Faster results
• Avoidance of unnecessary tests/ medications
• Patient Retention, reduced anxiety
• Rapid specific treatment
• Less pain/ easier to do
• Small volume of sample
• Odd hours – easy to do

30. Cons of POCT
• Poor sampling technique
• Poor record keeping
• Inappropriate testing
• Increased cost, multiple devices
• Difficult to detect abnormal samples,
hemolysed, lipaemic etc.
• Quality controls

31. POCT: Future
Microbiology
 Outbreaks / epidemics
 Methicillin resistant staph aureus
Endocrine testing to guide surgical therapy
 Parathyroid hormone
 ACTH
 Gastrin
 Growth hormone
Sepsis markers
Stroke markers
DNA testing

32. The FUTURE of POCT ?
HemaApp

33. Hardware

34. Bilicam

35. Decisions, Decisions
• Cost considerations
• Personnel training, accurate testing, reporting
LOOK FOR
• Inexpensive,
• Simple,
• Frequently performed
• With reasonable ROI

36. For most office practices
• Urine dipsticks for UTI
• Rapid strep Ag test
For many higher volume practices
• Hb
• WBC Diff
For Indoor practices/ ICU
• iSTAT for basic metabolic profile and hct etc.
• Alere Afinion - CRP, Hba1c, Lipid profile, CRP,
hba1c, Urine ACR, MicrAlbumen

37. • Convenience – Don’t LOSE your patient
• Fast results
• Rapid clinical decision making
• AAA

38. Missed something
docgaurav@gmail.com
www.slideshare.net/gauravg
Acknowledgments
• Dr Neeraj Kumar
• Hemocue.in – Dinesh, Abhishek, Mayank & Mohit