![]() Before a contrast-enhanced computed tomography scan, some patients have a recent creatinine result from an earlier blood test. The blood test measures creatinine, which is a marker of how well the kidneys work. A blood test can identify these patients before a computed tomography scan, to reduce the risk of kidney harm. After receiving a contrast agent (through a vein), some patients’ kidneys may be affected, especially if their kidneys already do not work well. Within this testing approach, the specific point-of-care device with the highest net benefit was i-STAT, although differences in net benefit with StatSensor were very small.īefore computed tomography scans are done, a contrast agent is usually needed to improve the visibility of internal body structures. In the base-case analysis, the cost-effective strategy appeared to be a three-step testing sequence involving initially screening all individuals for risk factors, point-of-care testing for those individuals with at least one risk factor, and including a final confirmatory laboratory test for individuals with a point-of-care-positive test result. Owing to limited data, the model included only i-STAT, ABL800 FLEX and StatSensor. The de novo decision model that was developed included a total of 14 strategies. The review of cost-effectiveness evidence identified no relevant studies. The review of implementation and clinical outcomes included six studies showing practice variation in the management decisions when a point-of-care device indicated an abnormal estimated glomerular filtration rate. There was limited evidence for epoc® (Siemens Healthineers AG, Erlangen, Germany) and Piccolo Xpress® (Abaxis, Inc., Union City, CA, USA) devices and no studies of DRI-CHEM NX 500 (Fujifilm Corporation, Tokyo, Japan). i-STAT (Abbott Point of Care, Inc., Princeton, NJ, USA) and ABL (Radiometer Ltd, Crawley, UK) devices had higher probabilities of correctly classifying individuals in the same estimated glomerular filtration rate categories as the reference laboratory test than StatSensor® devices (Nova Biomedical, Runcorn, UK). Twelve studies reported diagnostic accuracy for estimated glomerular filtration rates half were rated as being at low risk of bias, but there were applicability concerns for most. ![]() Scenario analyses were conducted.įifty-four studies were included in the clinical reviews. A range of alternative point-of-care testing approaches were considered. ![]() A de novo probabilistic decision tree cohort model was developed to characterise the decision problem from an NHS and a Personal Social Services perspective. Probabilities of individuals having their estimated glomerular filtration rates correctly classified were estimated within a Bayesian framework and pooled using a fixed-effects model. ![]() ![]() Risk of bias of diagnostic accuracy studies was assessed using a modified version of the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Studies comparing the accuracy of point-of-care creatinine tests with laboratory reference tests to assess kidney function in adults in a non-emergency setting and studies reporting implementation and clinical outcomes were included. Bibliographic databases were searched from inception to November 2018. Three systematic reviews of test accuracy, implementation and clinical outcomes, and economic analyses were carried out. ![]()
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