Validation of point-of-care tests used at in-home assessments among older adults in primary care.

Abstract

Background: Diagnosing acute disease in older adults is challenged by vague and atypical symptoms. Point-of-care tests (POCTs) at home may improve diagnostics and clinical decision-making. We compared various POCT devices to routine testing in acutely ill older adults to assess their clinical reliability.

Methods: We enrolled participants aged 65+ years requiring acute in-home assessment with signs of acute conditions. Venous and capillary blood samples were collected and analysed on-site using POCT, while identical samples were transported and analysed in a routine laboratory. Agreement between POCT and laboratory testing was assessed using scatter plots with linear regression, Pearson's correlation coefficient (PCC), limits of agreement, and Bland-Altman plots. Misclassification rates were calculated based on clinically meaningful cut-offs to assess POCT's clinical reliability.

Results: We included 100 participants with a mean age of 81.6 (±8.4 SD) years. Strong correlation was found between POCT and routine measurements (PCC: 0.76-0.94 for capillary samples and 0.85-0.98 for venous samples). Venous samples showed higher PCC than capillary, except for neutrophils (0.93 for capillary, 0.89 for venous). Misclassification occurred in capillary samples for haemoglobin (10/62) and total WBC (6/50), while in venous samples, misclassification was observed for haemoglobin (4/54), total WBC (4/50), K⁺ (5/47), urea (5/47), and creatinine (3/42). No misclassification was observed for Na⁺.

Conclusion: POCT provides acceptable, clinically reliable measurements in acutely ill older adults, potentially enhancing diagnostics and treatments during in-home assessment. Venous blood testing is preferable due to a lower misclassification rate, but capillary blood remains a pragmatic alternative, despite higher variation and inaccuracy.