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:
Does measurement of blood urea nitrogen (BUN) or creatinine at the point of care (vs the core laboratory) result in quicker time to treatment, decreased wait time, or decreased length of stay (LOS) for inpatient, emergency department (ED), dialysis, cardiovascular diagnostics laboratory (CVDL), or chemotherapy patients? (Literature Search 80 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Guideline 155. The guideline developers recommend against routinely providing point-of-care testing (POCT) for creatinine or BUN in the ED; they found fair evidence that POCT is ineffective in this environment.
Strength/consensus of recommendation: C
Level of evidence: II
Guideline 156. The guideline developers recommend that clinicians routinely provide POCT in the CVDL for creatinine and BUN; they found fair evidence that POCT in this environment improves important patient outcomes and that the benefits outweigh any potential harm.
Strength/consensus of recommendation: B
Level of evidence: II
Does screening for renal insufficiency by urine pH dipstick test at the point of care result in earlier diagnosis of renal insufficiency and fewer adverse events or decreased LOS for patients compared to screening by core laboratory urine pH testing? (Literature Search 81 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Guideline 157. The guideline developers are unable to recommend for or against routine use of POCT with urine pH dipstick to screen for renal insufficiency.
Strength/consensus of recommendation: I
Does screening for metabolic disorders using urine dipstick pH at the point of care result in earlier diagnosis of metabolic disorders, along with fewer adverse events and more rapid time to treatment for patients in outpatient clinics or the Neonatal Intensive Care Unit (NICU)/nursery when compared to screening by core laboratory urine pH testing? (Literature Search 82 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Guideline 158. The guideline developers are unable to recommend for or against routine use of urine dipstick pH testing for metabolic disorder screening at the point of care.
Strength/consensus of recommendation: I
Does measurement of urine specific gravity via dipstick testing at the point of care to evaluate renal function result in decreased patient wait time, quicker time to treatment, fewer adverse events, or decreased LOS for inpatient, ED, or outpatient clinic patients when compared to measurement of urine specific gravity in the core laboratory? (Literature Search 83 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Guideline 159. The guideline developers are unable to recommend for or against the routine use of urine dipsticks to measure urine specific gravity at the point of care for evaluation of renal function.
Strength/consensus of recommendation: I
Does assessment of specimen integrity by measurement of urine specific gravity by dipstick testing at the point of care result in fewer repeated patient visits because of invalid urine specimens in the ED, physician's office laboratory, or workplace drug testing setting? (Literature Search 84 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Guideline 160. The guideline developers cannot recommend for or against the routine use of urine specific gravity by dipstick testing for assessment of urine specimen integrity at the point of care.
Strength/consensus of recommendation: I
Does determination of hydration status by measurement of plasma, serum, whole blood, or urine osmolality at the point of care result in decreased patient wait time, quicker time to treatment, decreased LOS, or fewer adverse events for inpatient, ED, or outpatient clinic patients compared to measurement of osmolality in the core laboratory? (Literature Search 85 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Guideline 161. The guideline developers are unable to recommend for or against routine point of care measurement of osmolality—blood or urine—for determination of patient hydration status.
Strength/consensus of recommendation: I
Does screening for proteinuria using urine dipstick testing at the point of care to evaluate renal function result in decreased wait times, reduced time to treatment, fewer adverse events, and decreased LOS for inpatient, ED, or outpatient clinic patients when compared to urine protein screening using a core laboratory method? (Literature Search 86 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Guideline 162. The guideline developers recommend against routinely screening for proteinuria with urine dipstick testing at the point of care; they found fair evidence that POCT screening in this environment is ineffective for improving patient outcomes.
Strength/consensus of recommendation: C
Level of evidence: II
Does detection of glomerular dysfunction by evaluation of hematuria using dipstick testing at the point of care result in decreased wait times, reduced time to treatment, fewer adverse events, and decreased LOS for inpatient, ED, or outpatient clinic patients when compared to evaluation of hematuria using core laboratory urinalysis? (Literature Search 87 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Guideline 163. The guideline developers are unable to recommend for or against dipstick testing for hematuria to evaluate the extent of glomerular dysfunction at the point of care.
Strength/consensus of recommendation: I
Does analysis of urine or serum electrolytes at the point of care result in decreased wait times, reduced time to treatment, fewer adverse events, and decreased LOS for inpatient, ED, or outpatient clinic patients when compared to analysis of electrolytes using the core laboratory? (Literature Search 88 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Guideline 164. The guideline developers cannot recommend for or against measurement of urine or serum electrolytes at the point of care.
Strength/consensus of recommendation: I
Does evaluation for pregnancy-induced hypertension or preeclampsia using urine protein dipstick testing at the point of care result in decreased wait times, reduced time to treatment, fewer adverse events, and decreased LOS for ED, outpatient clinic, or labor and delivery patients when compared to urine protein measurement using core laboratory methods? (Literature Search 89 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Guideline 165. The guideline developers recommend against routine use of urine protein dipstick testing at the point of care for antenatal evaluation of hypertension or preeclampsia; they found fair evidence that protein dipstick testing in this environment is largely ineffective.
Strength/consensus of recommendation: C
Level of evidence: II
Does the use of urine dipstick pH testing at the point of care to predict renal stone recurrence result in decreased wait times, reduced time to treatment, fewer adverse events, and decreased LOS for inpatient, ED, or outpatient clinic patients compared to core laboratory urine pH testing? (Literature Search 90 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Guideline 166. The guideline developers are not able to recommend for or against routine use of urine dipstick pH testing at the point of care to predict renal stone recurrence.
Strength/consensus of recommendation: I
Does dipstick hematuria testing at the point of care to detect intraabdominal trauma result in decreased wait times, reduced time to treatment, fewer adverse events, and decreased LOS for ED patients compared to evaluation of hematuria using core laboratory urinalysis? (Literature Search 91 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Guideline 167. The guideline developers are unable to recommend for or against dipstick hematuria testing at the point of care to detect intraabdominal trauma.
Strength/consensus of recommendation: I
Does measurement of lactate at the point of care to assess or correct lactate buffer replacement in hemodialysis patients result in decreased wait times, reduced time to treatment, fewer adverse events, and decreased LOS? (Literature Search 92 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Guideline 168. The guideline developers cannot recommend for or against measurement of lactate at the point of care to assess or correct lactate buffer replacement in hemodialysis patients.
Strength/consensus of recommendation: I
Does detection of myoglobinuria using urine dipstick testing at the point of care as an indicator for possible renal complications of muscle injury result in decreased wait times, reduced time to treatment, fewer adverse events, and decreased LOS for inpatient, ED, and outpatient clinic patients when compared to evaluation of myoglobinuria using core laboratory urinalysis? (Literature Search 93 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Guideline 169. There is not sufficient evidence to recommend for or against urine dipstick testing for myoglobinuria at the point of care as an indicator for possible renal complications of muscle injury.
Strength/consensus of recommendation: I
Does measurement of microalbuminuria using dipstick testing at the point of care to assess nondiabetic nephropathy result in decreased wait times, reduced time to treatment, fewer adverse events, and decreased LOS for inpatient, ED, and outpatient clinic patients when compared to evaluation of microalbuminuria using core laboratory methods? (Literature Search 94 - Refer to Appendix B - see the "Availability of Companion Documents" field)
Guideline 170. The guideline developers are unable to recommend dipstick testing for microalbuminuria at the point of care to assess nondiabetic nephropathy.
Strength/consensus of recommendation: I
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.
