The document discusses the importance and advantages of point of care testing (POCT) in pediatric emergency medicine, emphasizing its role in improving patient care through rapid diagnosis and treatment decisions. It outlines various applications of POCT in managing diseases such as diabetes, sepsis, and COVID-19, along with its benefits in resource-limited settings. Additionally, it highlights the need for effective training and quality evaluation to ensure the proper use of POCT in healthcare environments.

1. Enhancing Pediatric Emergency Medicine
with
Point of Care Testing
Dr (Prof) Suresh Gupta
Senior Consultant and Co-Director
Pediatric Emergency & Critical Care Services
Institute of Child Health, Sir Ganga Ram Hospital, Delhi

2. From Doubt to Decision in Pediatric ER
Tirage
Vital Signs
History
Examination
Observe
Or
Not
Treat
Or
Not
Follow-Up
Or
Not
Investigate
Or
Not
Admit
Or
Discharge
Referral
Or
Not

4. History POCT
Egyptian physicians used ants to
determine glycosuria in patients
suspected of having diabetes mellitus

5. Point of Care Testing
(CAP)
Diagnostic Tests designed to be used at or
near the site where the patient is located,
that do not require permanent dedicatd
space, and that are performed outside the
physical facilities of the clinical
laboratories
OPD
ER/ICU
Field
Schoo
l
Medical Testing
At/Near the site
of Patient Care
the

6. POC Devices
• Quick acquisition of test results to guide right direction of treatment
of patient
• Early detection and planning of treatment
• Low turn around time

7. POCT: The value of decentralized diagnostics
• Changes to population and disease demographics
coupled withthe need formorecost-effective,faster, and
convenient diagnostics arerapidlytransforming care
delivery.
• Increasingly,diagnostic solutions need to
be closer to the patient, leading to the
decentralization of healthcare.

8. POCT has demonstrated its abilityto improvedisease management incardiac and infectious diseases, includingsepsis.16-19
Following COVID-19, the necessity of POCT to effectively monitor and manage infected patients, disease demographics,
and curb disease spreadbecame critical.20
Prevent stroke inatrial
fibrillation16
Atrial fibrillationaffects
over37 millionpeople
worldwide21
Prevent andimprove
heart failure17
Heartfailureaffects 64
millionpeopleworldwide22
Detect andmanage
acutemyocardial
infarction18
Prevalenceofacute
myocardialinfarctionis 3
millionpeopleworldwide23
Quicklydiagnose
sepsis19
Sepsis accounts
for11 milliondeaths
worldwideeachyear24
Effectivelymonitor
infectious deseases20
Over630millionconfirmed
COVID-
19 cases worldwide,
including over6.6 million
deaths25
How COVID-19 accelerated everything

9. POC Testing: ASSURED Criteria
Delivered to Needy
7
Minimum Equip.
6
Rapid & Robust
5
User-Friendly
4
Specific
3
Sensitive
2
Affordable
1

10. Role of POCT
Transition
Points

11. Advantages of POCT
01
Improves quality of
patient care
03
Increased patient and
physician satisfaction
02
Enhances efficiency of
patient care
04
Improves patient
education
05
Decrease risk
liability

12. POCT can benefit both healthcare systems
and patients, and lead to:
Enhanced operations
efficiencies
Patient engagement and
satisfaction
Improved patient care

13. POC Testing: Its Importance in Resource-
Limited Countries

20. POCT: Landscape
Microbiology
Equipment
Imaging
Blood Gas
Analyser
Haematology
Biochemistry

21. Examples

26. "Point of Care Diagnostics in Resource-Limited Settings: A
Review of the Present and Future of PoC in Its Most
Needed Environment" Biosensors 10, no. 10: 133.

27. Stretchable ultrasonic device
for hemodynamic monitoring

29. POC in Pediatric ER

31. Bedside POC Ultrasound
• Lung and heart images
• Fluid accumulation and drainage of pleural
fluid
• Abdominal USG
• Scrotal USG
• Cranial USG
• Optic Nerve Sheath Diameter
• Guidance for central line placement
Reduces radiation exposure

32. 01
02
03
04
Continuing Quality Evaluation
Clinical Governance
Ensuring Competency in using
POC
Competency
Training on how to use the
POC
Training
Residents/Nursing Education
Education
Ped ER - POC
Ped ER is the most fluid
environment in terms of
healthcare workers and
staff

33. Barriers

34. • Thank you

35. 6 weeks girl
• Brought to Ped ER, with fever for one day (rectal temp 101 F). Baby is
feeding okay. No other symptoms. Elder Sib 4 year had a fever with
cough and runny nose, 2 days back
How would you like to manage this infant
• Send home on antipyretics + antibiotics
• Admit to ward and start antibiotics after taking investigations
• POC Testing and then deciding the course of action

36. 6 weeks girl
• Brought to Ped ER, with fever for one day (rectal temp 101 F). Baby is
feeding okay. No other symptoms. Elder Sib 4 year had a fever with
cough and runny nose, 2 days back
How would you like to manage this infant
• Send home on antipyretics + antibiotics
• Admit to ward and start antibiotics after taking investigations
• POC Testing and then deciding the course of action
POC
CBC: HB 11, TLC 18000, DLC P 80, L
18, M 2
URINE: Leu Esterase +++, Nitrite +++,
ME: WBC 20-23 HPF
PCT: 30

37. Stool Microscopy Exam
Peripheral Smear: Toxic
Granules

38. Case scenario: 12 Yr Boy
• K/c/o type 1 DM on sc insulin, now presented with fever for 3 days
with polyuria, lethargy, tachypnea and petechial hemorrhages to ER.
• What all POCT will help you to assess the patient, categorize sickness
and decide admission to HDU?

39. 1. Pulse oximeter
2. ABG – acidosis, HB, hematocrit, glucose, sodium etc
3. BLOOD KETONE
4. Continuous glucose monitoring
5. DENGUE SPOT TEST
6. POCUS - lung
Case scenario: 12 Yr Boy

40. POC Testing vs POC Philosophy

41. POC Testing vs POC Philosophy
Best POC in Universe

44. Early screening
• Early detection of symptoms
• Contactless thermometers and pulse oximeters or forehead oximeters
• Wearable heart rhythm monitors, either in the form of chest straps
and belts or smart watches

45. Exposure to diagnosis
• From the time of exposure to symptom onset and subsequent
diagnosis disease
• Isolate/treat the patient early.
• Plan for further specific tests can be decided
• Eg- rapid antigen test for malaria, dengue card test

46. Diagnosis to stratification
• After an individual has been diagnosed with an infection, it’s crucial
to decide the condition of the patient.
• POCTs such as cutaneous oximetry, pulse oximetry, contactless
temperature sensing and measurement of a variety of markers in the
blood can be employed to decide the admission.

47. Stratification to escalating care
• Increasing oxygen demands and changes in certain parameters in the
blood allow physicians to make decisions about whether a patient
might need escalation of care

48. Monitoring to recovery
• Pulse oximetry
• ABG
• POCUS- lungs, cardiac
• Serology- IgM and IgG would assist in documenting immunity.

49. Qualitative strip-based devices
• These tests often provide qualitative results
• COVID-19 Ag Respi-Strip is a rapid SARS-CoV-2 antigen assay for the
diagnosis of COVID19 in 15 min

50. Unit-use analyzers
• Provide a quantitative readout of parameters after the reaction takes
place on test strips.
• OneTouch and AccuCheck glucometers
• i-STAT = lactate, hematology, chemistries and electrolytes, cardiac
markers, endocrinology, blood gases and coagulation

51. Benchtop POCT analyzers
• Siemens RAPIDPoint 500 Blood Gas System
1. Rapid - 60 s
2. Blood gases, electrolytes, glucose, lactate and full CO-oximetry from
samples including whole blood (arterial and venous), pleural fluid
and dialysate.
3. Touch screen, the connectivity to electronic health records through
barcodes, and remote monitoring and control

52. Continuous measurement with POCT systems
• Continuous glucose monitoring
• contact-free continuous heart rate and respiratory rate monitoring

53. Molecular biology-based POCT devices
• Helps to detect infectious agents
• Eg – Dengue, Typhidot