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Performance of Point-of-Care Diagnostics for Glucose, Lactate, and Hemoglobin in the Management of Severe Malaria in a Resource-Constrained Hospital in Uganda

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  • Division of Infectious Diseases, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine and Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Paediatrics and Child Health, Mulago Hospital and Makerere University, Kampala, Uganda; Department of Paediatrics, Jinja Regional Referral Hospital, Jinja, Uganda; Department of Medicine, University of Washington, Seattle, Washington; Division of Global Pediatrics, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; Sandra A. Rotman Laboratories, Sandra Rotman Centre for Global Health, Toronto, Ontario, Canada; Tropical Disease Unit, University Health Network–Toronto General Hospital, Toronto, Ontario, Canada

Severe malaria is frequently managed without access to laboratory testing. We report on the performance of point-of-care tests used to guide the management of a cohort of 179 children with severe malaria in a resource-limited Ugandan hospital. Correlation coefficients between paired measurements for glucose (i-STAT and One Touch Ultra), lactate (i-STAT and Lactate Scout), and hemoglobin (Hb; laboratory and i-STAT) were 0.86, 0.85, and 0.73, respectively. The OneTouch Ultra glucometer readings deviated systematically from the i-STAT values by +1.7 mmol/L. Lactate Scout values were systematically higher than i-STAT by +0.86 mmol/L. Lactate measurements from either device predicted subsequent mortality. Hb estimation by the i-STAT instrument was unbiased, with upper and lower limits of agreement of −34 and +34 g/L, and it was 91% sensitive and 89% specific for the diagnosis of severe anemia (Hb < 50 g/L). New commercially available bedside diagnostic tools, although imperfect, may expedite clinical decision-making in the management of critically ill children in resource-constrained settings.

Author Notes

* Address correspondence to Michael Hawkes, Division of Infectious Diseases, Department of Pediatrics, University of Alberta, 11405 87 Avenue, ECHA 3-588, Edmonton, AB, Canada T6G 1C9. E-mail: mthawkes@ualberta.ca

Financial support: This work was supported by a kind donation from Kim Kertland, the Tesari Foundation, the Sandra Rotman Centre for Global Health, a Post-Doctoral Research Award (to M.H. and A.L.C.), Canadian Institutes of Health Research Grants MOP-244701 (to K.C.K.) and MOP-13721 (to K.C.K.), and a Canada Research Chair (K.C.K.).

Authors' addresses: Michael Hawkes, Division of Infectious Diseases, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada, E-mail: mthawkes@ualberta.ca. Andrea L. Conroy and Kevin C. Kain, Department of Medicine and Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada, E-mails: andrea.conroy@gmail.com and kevin.kain@uhn.ca. Robert O. Opoka, Department of Paediatrics and Child Health, Mulago Hospital and Makerere University, Kampala, Uganda, E-mail: opokabob@yahoo.com. Sophie Namasopo, Department of Paediatrics, Jinja Regional Referral Hospital, Jinja, Uganda, E-mail: snamasopo@yahoo.com. W. Conrad Liles, Department of Medicine, University of Washington, Seattle, WA, E-mail: wcliles@medicine.washington.edu. Chandy C. John, Division of Global Pediatrics, Department of Pediatrics, University of Minnesota, Minneapolis, MN, E-mail: ccj@umn.edu.

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