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2017 ; 25
(1
): 24
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Can we rely on out-of-hospital blood samples? A prospective interventional study
on the pre-analytical stability of blood samples under prehospital emergency
medicine conditions
#MMPMID28259184
Prottengeier J
; Jess N
; Harig F
; Gall C
; Schmidt J
; Birkholz T
Scand J Trauma Resusc Emerg Med
2017[Mar]; 25
(1
): 24
PMID28259184
show ga
BACKGROUND: Prehospital intravenous access provides the opportunity to sample
blood from an emergency patient at the earliest possible moment in the course of
acute illness and in a state prior to therapeutic interventions. Our study
investigates the pre-analytical stability of biomarkers in prehospital emergency
medicine and will answer the question whether an approach of blood sampling out
in the field will deliver valid laboratory results. METHODS: We prepared pairs of
blood samples from healthy volunteers and volunteering patients post
cardio-thoracic surgery. While one sample set was analysed immediately, the other
one was subjected to a worse-than-reality treatment of 60 min time-lapse and
standardized mechanical forces outside of the hospital through actual ambulance
transport. We investigated 21 parameters comprising blood cells, coagulation
tests, electrolytes, markers of haemolysis and markers of cardiac ischemia.
Bland-Altman analysis was used to investigate differences between test groups.
Differences between test groups were set against the official margins of test
accuracy as given by the German Requirements for Quality Assurance of Medical
Laboratory Examinations. RESULTS: Agreement between immediate analysis and our
prehospital treatment is high as demonstrated by Bland-Altman plotting.
Mechanical stress and time delay do not produce a systematic bias but only random
inaccuracy. The limits of agreement for the tested parameters are generally
within clinically acceptable ranges of variation and within the official margins
as set by the German Requirements for Quality Assurance of Medical Laboratory
Examinations. DISCUSSION: We subjected blood samples to a standardized treatment
marking a worse-than-reality scenario of prehospital time delay and transport.
Biomarkers including indicators of myocardial ischemia showed high pre-analytical
stability. CONCLUSION: We conclude the validity of blood samples from a
prehospital environment.