Effect of beta-hCG with a Point-of-Care Test in the Emergency Department

ABSTRACT

PURPOSE: The rapid and accurate diagnosis of pregnancy is important in the emergency department (ED) before evaluation of radiologic tests and medication decisions. Our primary objective was to assess the agreement between whole blood pregnancy tests done in the emergency department and those done in laboratory [serum human chorionic gonadotropin (beta-hCG) and urine beta-hCG]. The secondary objective was to compare turnaround times for tests done in the ED and those done in the laboratory. METHODS: This prospective study enrolled females of childbearing age needing a pregnancy test who visited an ED. Using whole blood, urine and serum from each patient, testing was done in the ED (whole blood - Hubi Quan pro-point of care test, POCT) and in the laboratory using a urine hCG kit (iIexscreen) and in serum (ADVIA centaur). The data included time of each test, beta-hCG result, and urine pregnancy test result. RESULTS: There was a high level of agreement between the POCT using whole blood and the serum beta-hCG as indicated by a kappa value of 0.921(95% confidence interval). The POCT performed in the ED was significantly faster in time to report than tests performed in the laboratory, with mean differences of 20.21+/-2.0 minutes and 36.14+/-20.86 minutes. The sensitivity and specificity of POCT was 98.18% and 93.75%, respectively. CONCLUSION: In ED, the POCT test can perform pregnancy test as accurately as in the laboratory, and can provide results on which to base care much faster than waiting for the laboratory results. POCT may expedite the ED management of patients who require pregnancy tests. Especially, this POCT uses whole blood instead of the urine, since the latter was inconvenient for the test.