Guided release of a breath (GRAB) – bringing urea breath test (UBT) to the doorstep

ABSTRACT

BackgroundUrea Breath Tests (UBTs) are common non-invasive tests performed in hospitals under the guidance of trained technicians. However, COVID-19 has reduced access to within-hospital UBTs. Self-conducted UBT (SUBT) at home has been suggested as an alternative. This study aims to compare the efficacy of SUBT with written compared to video instructions.MethodsThe study was divided into 3 parts. In Part 1, consecutive first-time UBT patients were randomized to receive either written or video instructions. In Part 2, the original video was enhanced. For Parts 1 and 2, a competency score of 1-5 based on the assessment of the 5 key steps was determined by a trained observer. Having reviewed the steps for breath collection in the first 2 parts, we went on to Part 3 to determine if breath collection with these steps would be successful. A further enhanced instructional video was created and successful collection of breath was recorded based on detection of sufficient recovered C-13 in the breath bag for the baseline test.ResultsIn total, 129 patients were recruited for the study. Patients excluded for this study included those who had visual or hearing impairment, cognitive impairment and those who did not understand English as our instructional materials were in English. For Part 1, 20 patients were randomised into written (n=10) and original video (n=10) groups. There was numerical improvement but no statistically significant difference in median scores for written and video instructions (2 vs 4, p=0.055). A further 10 patients were recruited for Part 2, the enhanced video group. Median scores were statistically improved for enhanced video compared to written (5 vs 2, p=0.043). In Part 3, 99 patients were recruited. Barring machine fault, all the UBTs were successful without repeating the breath test.ConclusionsAn enhanced instructional video is highly successful at enabling SUBT. This can improve the safety of patients and operators by allowing UBTs to be conducted at home, while maintaining accuracy. This would reduce the time that patients spend in the hospital and reduce exposure to potential COVID infections.