Impact of point of care testing in time to treatment decision-making in emergency departments: a systematic review.

Abstract

The main characteristic of point-of-care testing (PoCT) is to provide rapid test results. It remains uncertain whether faster PoCT results truly improve patient management in the emergency department (ED), and how robust the supporting evidence is. This systematic review aimed to summarize the impact of PoCT in ED on time to clinical decision-making and major clinical outcomes (ED LOS, TAT, mortality, hospitalization, discharge, readmission or antibiotic administration). We searched PubMed, Embase and CENTRAL to identify studies evaluating PoCT in ED. The primary outcomes were the time to decision making and reduction in ED length of stay (LOS). We included 55 studies (approximately 142,000 subjects) evaluating molecular test for virus (n=19) or bacteria (n=2) detection, gastrointestinal infection (n=1), biochemical panel (n=12), troponin (n=9), C-reactive protein (n=2), lactate (n=3), human chorionic gonadotropin (HCG, n=2), d-dimer (n=1), monocyte distribution width (MDW, n=1), blood culture (n=1) and urinary tract infection (n=1) tests. Overall, the use PoCT reduced time to decision-making (ranged from -73 min to -96 min) and ED-LOS (MD -29.24 min 95 % CI from -46.11 to -12.38 min) compared to central laboratory testing. No significant differences were observed for major clinical outcomes. Although substantial statistical heterogeneity was identified, PoCT appears to guide faster clinical decision-making without any detrimental effects on clinical outcomes compared to standard laboratory testing. Future research should better define context dependent applications of PoCT translating faster results into meaningful changes in patient pathways and healthcare processes.