Point-of-Care Testing

Book
In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
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Excerpt

Point-of-Care Testing (POCT) is clinical laboratory testing conducted close to the site of patient care where care or treatment is provided. POCT provides rapid turnaround of test results with the potential to generate a result quickly so that appropriate treatment can be implemented, leading to improved clinical or economic outcomes compared to laboratory testing.

Traditional laboratory testing typically involves a multiple-step process that includes collecting samples from the patient at the bedside or the clinic, transporting them to a centralized laboratory (often located far away), and then subjecting the samples to several processing steps. The delay in treatment caused by the time-consuming traditional laboratory testing can hinder timely clinical decision-making. POCT addresses this challenge by bringing the laboratory to the patient. Portable and handheld testing devices enable healthcare workers to perform rapid testing on samples, significantly reducing the time needed for medical decision-making.

The concept of on-site or near-patient testing for blood analysis was initially explored in England during the 1950s and was referred to as "near-patient testing." In the early 1980s, Dr. Gerald J. Kost introduced the term "point-of-care testing" after extensive research on the application of biosensors for monitoring ionized calcium levels in whole blood. The term "point-of-care testing" was subsequently codified with the definition of "testing at or near the site of patient care."

Technological advances, including the miniaturization of electronics and improved instrumentation, have facilitated the development of increasingly smaller and more accurate POCT devices. Cutting-edge POCT integrates microneedles and microfluidics for improved comfort, speed, and accuracy.

The following features of POCT are ubiquitous:

  1. POCT should be simple to use.

  2. Reagents and consumables should have durable resistance during storage and use.

  3. POCT results should align with established laboratory methods.

  4. POCT should ensure safety during testing.

Various guidelines, such as the ASSURED Guidelines by the World Health Organization (WHO), exist for specific subsets of POCT, such as sexually transmitted infections (STI). The ASSURED acronym stands for Affordable, Sensitive, Specific, User-friendly, Rapid, Robust, Equipment-free, and Delivered (to the end user), which are key criteria for effective POCT, as proposed by the World Health Organization (WHO). Affordable is for patients at risk of infection, and equipment-free means no complex equipment is required.

The National Academy of Clinical Biochemistry (NACB) has developed evidence-based guidelines for POCT, providing grading and recommendations to optimize the use of POCT based on scientific research and clinical evidence.

POCT guidelines generally emphasize the rapid results and cost-effectiveness of POCT, along with the importance of high sensitivities and specificities to support informed clinical decision-making.

Publication types

  • Study Guide