Definitions of the levels of evidence (I—III) and grades of the recommendation (A, B, C, I) are presented at the end of the "Major Recommendations" field.
Note from the National Academy of Clinical Biochemistry (NACB) and the National Guideline Clearinghouse (NGC): The Laboratory Medicine Practice Guidelines (LMPG) evidence-based practice for point-of-care testing sponsored by the NACB have been divided into individual summaries covering disease- and test-specific areas. In addition to the current summary, the following are available:
Arterial Blood Gases (ABG)
Intensive Care Unit (ICU)
Guideline 37. There is fair evidence that more rapid therapeutic turnaround time (TTAT) of ABG results in several types of ICU patients leads to improved clinical outcomes. Overall, the guideline developers recommend that more rapid TTAT of ABG results be considered as a way to improve outcomes in at least some types of ICU patients. (Literature Search 13 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Strength/consensus of recommendation: B
Level of evidence: I
Guideline 38. There is fair evidence that point-of-care testing (POCT) of ABG results in the ICU leads to improved clinical outcomes when POCT is found to lead to reduced TTAT compared to that in the central laboratory. Overall, the guideline developers recommend that POCT of ABG results be considered as a way to improve outcomes in ICU patients. More prospective randomized controlled studies need to be performed. (Literature Search 14 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Strength/consensus of recommendation: B
Level of evidence: II
Guideline 39. There is some evidence that POCT of ABG results in the ICU may lead to reduced costs when compared to the central laboratory testing, but the balance of benefit to no benefit is too close to justify in a given hospital. The guideline developers have no recommendation for POCT of ABG results being considered as a way to reduce costs in the ICU. More prospective randomized controlled studies need to be performed. (Literature Search 15 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Strength/consensus of recommendation: I
Level of evidence: II
Emergency Department (ED)
Guideline 40. There is fair evidence that more rapid TTAT of ABG results, in some ED patients, leads to improved clinical outcomes. Overall, the guideline developers recommend that more rapid TTAT of ABG results be considered as a way to improve outcomes in at least some types of ED patients. (Literature Search 16 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Strength/consensus of recommendation: B
Level of evidence: II
Guideline 41. There is fair evidence that POCT of ABG results leads to improved clinical outcomes in some types of ED patients when POCT is found to lead to reduced TTAT compared with that of the central laboratory. Overall, the guideline developers recommend that POCT of ABG results be considered as a way to improve outcomes in ED patients. More prospective randomized controlled studies need to be performed. (Literature Search 17 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Strength/consensus of recommendation: B
Level of evidence: II
Cardiac Surgery: Adult and Neonatal
Guideline 42. There is fair evidence that more rapid TTAT of ABG results in cardiac surgery patients leads to improved clinical outcomes. Overall, the guideline developers recommend that more rapid TTAT of ABG results be considered as a way to improve outcomes in cardiac surgery patients. (Literature Search 18 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Strength/consensus of recommendation: B
Level of evidence: II
Guideline 43. There is fair evidence that POCT of ABG results leads to improved clinical outcomes in cardiac surgery patients when POCT is found to lead to reduced TTAT compared to that of the central laboratory. Overall, the guideline developers recommend that POCT of ABG results be considered as a way to improve outcomes in cardiac surgery patients. More prospective randomized controlled studies need to be performed. (Literature Search 19 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Strength/consensus of recommendation: B
Level of evidence: II
Glucose
Guideline 44. There is good evidence that more rapid TTAT of glucose results in critical care patient settings leads to improved clinical outcomes. Overall, the guideline developers strongly recommend that more rapid TTAT of glucose results be considered as a way to improve outcomes in critical care patients. (Literature Search 20 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Strength/consensus of recommendation: A
Level of evidence: I
Guideline 45. There is good evidence that POCT of glucose results leads to improved clinical outcomes in critical care patient settings when POCT is found to lead to reduced TTAT compared to that of the central laboratory. Overall, the guideline developers strongly recommend that POCT of glucose results be considered as a way to improve outcomes in critical care patients. (Literature Search 21 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Strength/consensus of recommendation: A
Level of evidence: I
Lactate
Guideline 46. There is good evidence that more rapid TTAT of lactate results in critical care patient settings leads to improved clinical outcomes. Overall, the guideline developers strongly recommend that more rapid TTAT of lactate results be considered as a way to improve outcomes in ED, operating room (OR), and ICU patients. (Literature Search 22 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Strength/consensus of recommendation: A
Level of evidence: I
Guideline 47. There is good evidence that POCT of lactate results leads to improved clinical outcomes in critical care patient settings when POCT is found to lead to reduced TTAT compared to that of the central laboratory. Overall, the guideline developers recommend that POCT of lactate results be considered as a way to improve outcomes in critical care patients. More prospective randomized controlled studies need to be performed. (Literature Search 23 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Strength/consensus of recommendation: B
Level of evidence: II
Magnesium
Guideline 48. There is fair evidence that more rapid TTAT of magnesium results in critical care patient settings leads to improved clinical outcomes. Overall, the guideline developers recommend that more rapid TTAT of magnesium results be considered as a way to improve outcomes in critical care patient settings. (Literature Search 24 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Strength/consensus of recommendation: B
Level of evidence: II
Guideline 49. There is insufficient evidence that POCT of magnesium results leads to improved clinical outcomes in critical care patient settings. Overall, the guideline developers recommend that prospective randomized controlled studies be performed. (Literature Search 25 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Strength/consensus of recommendation: I
Level of evidence: III
Cooximetry
Oxygen Saturation
Guideline 50. There is fair evidence that more rapid TTAT of oxygen saturation results in critical care patient settings leads to improved clinical outcomes. Overall, the guideline developers recommend that rapid TTAT of oxygen saturation results be considered as a way to improve outcomes in critical care patient settings. (Literature Search 26 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Strength/consensus of recommendation: B
Level of evidence: II
Guideline 51. POCT of oxygen saturation by cooximetry is not required in critical care settings. Overall, the guideline developers recommend pulse oximetry as the preferred method. (Literature Search 27 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Strength/consensus of recommendation: C
Level of evidence: II
Carboxyhemoglobin (HbCO)
Guideline 52. There is good evidence that POCT of HbCO results leads to improved clinical outcomes in critical care patient settings when POCT is found to lead to reduced TTAT compared to that of the central laboratory. Overall, the guideline developers recommend that POCT of HbCO results be considered as a way to improve outcomes in critical care patients. More prospective randomized controlled studies need to be performed. (Literature Search 28 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Strength/consensus of recommendation: B
Level of evidence: II
Methemoglobin (MetHb)
Guideline 53. There is fair evidence that POCT of MetHb results leads to improved clinical outcomes in critical care patient settings. Overall, the guideline developers recommend that POCT of MetHb results be considered as a way to improve outcomes in critical care patients and that more prospective randomized controlled studies need to be performed. (Literature Search 29 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Strength/consensus of recommendation: B
Level of evidence: II
Electrolytes (Sodium [Na+], Potassium [K+], Chloride [Cl-])
Emergency Department
Guideline 54. There is fair evidence that POCT of potassium results leads to improved clinical outcomes in ED patients when POCT is found to lead to reduced TTAT compared to that of the central laboratory. Overall, the guideline developers recommend that POCT of potassium results be considered as a way to improve outcomes in ED patients. More prospective randomized controlled studies need to be performed. (Literature Search 30 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Strength/consensus of recommendation: B
Level of evidence: II
Intensive Care Unit
Guideline 55. There is little known evidence that POCT of electrolyte results leads to improved clinical outcomes in the ICU setting. Overall, the guideline developers have no recommendation for POCT of electrolyte results being considered as a way to improve outcomes in the ICU. Prospective randomized controlled studies need to be performed. (Literature Search 31 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Strength/consensus of recommendation: I
Level of evidence: III
Ionized Calcium
Emergency Department
Guideline 56. There is fair evidence that POCT of ionized calcium results leads to improved clinical outcomes in circulatory arrest patients when POCT is found to lead to reduced TTAT compared to that of the central laboratory. Overall, the guideline developers recommend that POCT of ionized calcium results be considered as a way to improve outcomes in circulatory arrest patients. More prospective randomized controlled studies need to be performed. (Literature Search 32 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Strength/consensus of recommendation: B
Level of evidence: II
Operating Room
Guideline 57. There is little evidence that POCT of ionized calcium results leads to improved clinical outcomes in surgical patients when POCT is found to lead to reduced TTAT compared to that of the central laboratory. Overall, the guideline developers cannot recommend that POCT of ionized calcium results be considered as a way to improve outcomes in surgical patients. More prospective randomized controlled studies need to be performed. (Literature Search 33 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Strength/consensus of recommendation: I
Level of evidence: III
Intensive Care Unit
Guideline 58. There is fair evidence that more rapid TTAT of ionized calcium results in the ICU leads to improved clinical outcomes. Overall, the guideline developers recommend that more rapid TTAT of ionized calcium results be considered as a way to improve outcomes in ICU patients. (Literature Search 34 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Strength/consensus of recommendation: B
Level of evidence: II
Guideline 59. There is fair evidence that POCT of ionized calcium results leads to improved clinical outcomes in ICU patients when POCT is found to lead to reduced TTAT compared to that of the central laboratory. Overall, the guideline developers recommend that POCT of ionized calcium results be considered as a way to improve outcomes in ICU patients. More prospective randomized controlled studies need to be performed. (Literature Search 35 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Strength/consensus of recommendation: B
Level of evidence: II
Definitions:
Levels of Evidence
- Evidence includes consistent results from well-designed, well-conducted studies in representative populations.
- Evidence is sufficient to determine effects, but the strength of the evidence is limited by the number, quality, or consistency of the individual studies; generalizability to routine practice; or indirect nature of the evidence.
- Evidence is insufficient to assess the effects on health outcomes because of limited number or power of studies, important flaws in their design or conduct, gaps in the chain of evidence, or lack of information.
Strength of Recommendations
A - The National Academy of Clinical Biochemistry (NACB) strongly recommends adoption; there is good evidence that it improves important health outcomes and concludes that benefits substantially outweigh harms.
B - The NACB recommends adoption; there is at least fair evidence that it improves important health outcomes and concludes that benefits outweigh harms.
C - The NACB recommends against adoption; there is evidence that it is ineffective or that harms outweigh benefits.
I - The NACB concludes that the evidence is insufficient to make recommendations; evidence that it is effective is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.
