A-400 11 month study of thrice daily testing of blood samples on dual GEM 5000s demonstrates 24 hour new cartridge instability
Notice bibliographique
Résumé
Abstract Background Kingston Hospital has conducted a 11 month (January 1-November 29, 2024) quality monitoring study in which a previously analyzed patient venous or arterial whole blood sample is analyzed every eight hours on two central laboratory-situated GEM 5000 blood gas/electrolyte analyzers. Using the Dahlberg calculation to derive the standard deviation of the duplicate analyses on both systems, we correlated and quantitated the inter-analyzer repeatability of 12 analytes measured by the two analyzers across and within multiple cartridge pairs. Methods Sodium, potassium, chloride, ionized calcium, glucose, lactate, pH, pCO2, pO2, hemoglobin, carboxyhemoglobin and methemoglobin were measured. For every analyte, we matched each 8-hour inter-analyzer difference to the current cartridge combination over the entire lifetime of the cartridge combination. We used the Dahlberg calculation to determine the variation of each different cartridge combination and the overall variation for each unique 8 h period (from period 1 starting with cartridge replacement to the eventual period of cartridge change). Results Over 11 months, 105 cartridges were used, 59 in one analyzer and 46 in the other analyzer. Variation was measured within 95 double cartridge combinations and across up to 21 testing periods (7 days). The Figure shows the Dahlberg-derived between instrument repeatability from cartridge change to testing period 20. Increased variation between the two analyzers is obvious at 8 and 16 hours after a cartridge replacement. The variation tends to decrease after 24 hours and can decrease for 3 or 4 days (e.g. pH and iCa). The average analyte levels, their maximum variations on day 1 and median variations between days 2 through 7 follow: pH, 7.37, 0.013, 0.007; pCO2 44.3, 1.16, 0.76 mmHg; pO2, 50.7, 2.54, 1.75 mm Hg; sodium, 134.3, 0.88, 0.71 mmol/L; potassium, 4.3, 0.076, 0.072 mmol/L; chloride, 102.1, 0.77, 0.81 mmol/L; ionized calcium (iCa), 1.20, 0.017, 0.014 mmol/L; glucose, 7.8, 0.36, 0.25 mmol/L; lactate 1.74, 0.14, 0.08 mmol/L; hemoglobin 121, 2.0, 1.6 g/L; methemoglobin 0.52, 0.31 and 0.28% and carboxyhemoglobin 1.7, 0.36 and 0.30%. For iCa and pO2, the F-test demonstrates that the distributions of the post 24-hour testing are statistically different from the 8 to 24 hour testing. It should be noted that the variations obtained in the first 24 hours post cartridge change exceed most of the variations documented in published GEM 5000 evaluations. The glucose instability should be noted and might introduce complexities whenever hospital patients begin to use their own continuing glucose monitoring (CGM) devices. Conclusion Testing may not be optimal on the first day of a GEM 5000 cartridge change. New cartridge instability can be efficiently ruled out by analyzing three different retained fresh blood specimens on two analyzers – the analyzer with the replacement cartridge and its backup. Otherwise, to mitigate the reporting of potentially misleading results, we suggest results be produced with the analyzer using cartridges installed a minimum of 16 to 24 hours earlier.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,008 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
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