A-400 11 month study of thrice daily testing of blood samples on dual GEM 5000s demonstrates 24 hour new cartridge instability
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".