Troponin Comparsion
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We have become a 4 hospital system. Three of those use i-STAT. There is some debate over comparing methods. How are you comparing the i-STAT with your chemistry analyzer twice a year for troponin?
Dee Dee Mason MT (AMT)
Point of Care Coordinator/Laboratory TeamLeader
Phoebe Putney Health System
417 3RD Ave
Albany, Ga. 31701
229-312-6166
Fax: 229-312-6105
Email:
dmason@ppmh.org
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Dee Dee,
Even though our POC CLIA is separate from the Main Lab, we perform 5 patient comparisons to the Main Lab twice per year. We time these with the CLEW updates. Staff in the ED perform a Calibration Verification and run 5 samples for Troponin that are also sent to the Main Lab analyzer. Of course we have a special NO CHARGE account so the patient is not billed twice.
thanks,
Carrie
Dee Dee
At St Mary's Janesville, We discontinued i-stat troponins due to the confusion between methods and ranges with the providers; but when we did use the i-stat troponins we compared by drawing an extra tube on the same patient and running them as closely together as possible on the chemistry analyzer and the i-stat. I also compared spun and unspun and saw little variation on the i-stat result. I would run comparisons for the troponin plus other cartridges at the same time I did the six month cal-ver.
Dee Dee~
I pull 5 plasma samples and one whole blood/green top that comes to main lab. I rerun plasma samples for better correlation. I also perform this around the CLEW updates. Works well.
Thanks, Amber
Amber, you mentioned that you performed comparisons with clew updates. So it would be ok to use qc material as your sample for istat to istat, correct?
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I run my troponin correlations with all other iSTAT using a whole blood green top tube, usually left over from an iCA or blood gas syringe and run on iSTAT then spin and run on the Centaur. We look for clinical concordance as the iSTAT result reads much lower than the Centaur. I also pull any ER patients that both the iSTAT and Lab testing was done which helps to get the higher values. ivy
Is there a regulation for the number of sample that you need to do for every 6-month correlation, or it depends on your institution? We are doing 5, I am just wondering if we can decrease the # of samples?
Do you do 1 istat analyzer per sample?
Or 1 sample on multiple iSTAT analyzers?
Thanks
Don’t we need 20 points for correlation?
Jeremy Williford, PBT (ASCP)
Point of Care Support Specialist, Clinical Laboratory Services
South Georgia Medical Center | 2501 N Patterson St. | Valdosta, GA 31602
229.259.4804 (office) |
229.249-5461 (fax)
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We do 5 because we calculate the statistics ( SD, CV, Bias, etc) of the comparison in EP evaluator.
5 is the minimum number of samples it require to get a meaningful result.
I don’t think the number of comparison for the biannual comparison is specified.
The more the better but 20 Troponin will be a little expensive.
Does Abbott define acceptable criteria for concordance values?
Thanks,
Jennifer
Agree with Pet that performing 20 patient comparisons biannually would be a bit expensive and that the number of comparisons is not specified in any regulation or checklist item. I think it would also be excessive. You have probably already run many (20+) patient comparisons during your initial instrument validation and the biannual comparison is not a revalidation. Also, you are performing proficiency and maybe run verification samples as well as previously analyzed competency samples on many of those instruments so you probably know that instruments are not comparing favorably.
All of this "How many....what time frame etc." comes down to what is in your procedure. How many does the procedure require? Have you written it differently for the tests that have a lower volume? (I did but the minimum is always 5.) Have you tried to track patient tests in the computer with draw times with a main lab test? (we have to do this in some really low volume instances especially when time is short at the end of 6 month timeframe.)
Also, the comparison of ISTAT to ISTAT can be done with QC. The CAP standard would prefer patient samples but when you are in numbers of ISTAT that are above 85+...that is too expensive.
Ensure that you are not comparing them across CLIA numbers-especially it PT is used for any of this. We no longer run PT on ISTAT except for ACT so we use no PT for comparisons.
Deanna Bogner 210-297-9657