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Cervellin G.,Unita Operativa Pronto Soccorso e Medicina dUrgenza | Mattiuzzi C.,Servizio Governance Clinica
Biochemia Medica | Year: 2013

Background: A number of preanalytical activities strongly infl uence sample quality, especially those related to sample collection. Since blood drawing through intravenous catheters is reported as a potential source of erythrocyte injury, we performed a critical review and meta-analysis about the risk of catheter-related hemolysis. Materials and methods: We performed a systematic search on PubMed, Web of Science and Scopus to estimate the risk of spurious hemolysis in blood samples collected from intravenous catheters. A meta-analysis with calculation of Odds ratio (OR) and Relative risk (RR) along with 95% Confi dence interval (95% CI) was carried out using random effect mode. Results: Fifteen articles including 17 studies were fi nally selected. The total number of patients was 14,796 in 13 studies assessing catheter and evacuated tubes versus straight needle and evacuated tubes, and 1251 in 4 studies assessing catheter and evacuated tubes versus catheter and manual aspiration. A signifi cant risk of hemolysis was found in studies assessing catheter and evacuated tubes versus straight needle and evacuated tubes (random effect OR 3.4; 95% CI = 2.9-3.9 and random effect RR 1.07; 95% CI = 1.06-1.08), as well as in studies assessing catheter and evacuated tubes versus catheter and manual aspiration of blood (OR 3.7; 95% CI = 2.7-5.1 and RR 1.32; 95% CI = 1.24-1.40). Conclusions: Sample collection through intravenous catheters is associated with signifi cant higher risk of spurious hemolysis as compared with standard blood drawn by straight needle, and this risk is further amplifi ed when intravenous catheter are associated with primary evacuated blood tubes as compared with manual aspiration. Source


Carbucicchio A.,Unita Operativa Pronto Soccorso e Medicina dUrgenza | Benatti M.,Unita Operativa Pronto Soccorso e Medicina dUrgenza | Cervellin G.,Unita Operativa Pronto Soccorso e Medicina dUrgenza
Blood Coagulation and Fibrinolysis | Year: 2013

We planned a prospective study to assess platelet number and size in patients with or without brain injury after mild head trauma (MHT). Platelet count and mean platelet volume (MPV) were assessed in consecutive patients admitted to the emergency department with isolate MHT, as well as in healthy blood donors who served as controls. The study population consisted in 54 patients with MHT, 13 of whom (24%) with intracranial lesions suggestive for brain injury, and 339 healthy blood donors. The value of platelet count was significantly lower in patients with MHT and positive computerized tomography than in healthy controls (P=0.014). The vales of MPV progressively decreased from healthy controls (11.1fl) to patients with MHT and negative computerized tomography (9.8fl; P<0.001), and further to patients with MHT and positive computerized tomography (8.6fl; P<0.001). The MPV was significantly lower in patients with MHT and positive computerized tomography than in those with negative computerized tomography (P=0.002). As compared with healthy controls, the frequency of decreased MPV values was 10-fold and 17-fold higher in MTH patients with negative and positive computerized tomography, respectively. The MPV exhibited an area under the curve of 0.74 (95% CI, 0.58 to 0.89; P<0.001) for differentiating MHT patients with positive computerized tomography from those with negative computerized tomography. MHT patients display a larger prevalence of small and hyporeactive platelets. This observation provides a reliable basis for planning further studies to establish whether MPV may be useful for diagnostic evaluation of MHT in the emergency department. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source


Mattiuzzi C.,Servizio Governance Clinica | Comelli I.,Unita Operativa Pronto Soccorso e Medicina dUrgenza | Cervellin G.,Unita Operativa Pronto Soccorso e Medicina dUrgenza
Blood Coagulation and Fibrinolysis | Year: 2013

It is now widely acknowledged that larger platelets are biologically more active and express a greater prothrombotic potential, but there is no definitive evidence on the diagnostic accuracy role of mean platelet volume (MPV) in patients with ischemic heart disease. We performed an electronic search for articles that have assessed the diagnostic accuracy of MPV in patients admitted at the emergency department with a suspected diagnosis of ischemic heart disease, including articles in which the exact number of true-positive, false-positive, false-negative and true-negative test results could be either directly or indirectly extracted. Heterogeneity was assessed by I test. The cumulative estimates and 95% confidence interval (95% CI) of sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), area under the receiver operator characteristic (ROC) curve (AUC) and diagnostic odds ratio (DOR) were calculated using a random effect model. Three studies were finally included in our analysis (mean quality score, 10.8) totaling 3577 participants (566 cases and 3011 controls). The between-study variation was high (I, 96.2%; P<0.001). The pooled estimates were 0.820 (95% CI 0.786-0.851) for sensitivity, 0.461 (95% CI 0.443-0.479) for specificity, 0.932 (95% CI 0.918-0.944) for NPV and 0.222 (95% CI 0.205-0.241) for PPV and 0.652 (95% CI 0.596-0.707) for AUC. The DOR was 3.9 (95% CI 2.3-6.5), with 0.52 diagnostic accuracy. The outcome of this meta-analysis suggests that MPV does not meet the requirements for efficient triage of patients in emergency department when used as stand-alone test, whereas its combination with high-sensitive troponin immunoassays merits further investigations. © 2013 Wolters Kluwer Health Lippincott Williams & Wilkins. Source


Mattiuzzi C.,Servizio Governance Clinica | Comelli I.,Unita Operativa Pronto Soccorso e Medicina dUrgenza | Cervellin G.,Unita Operativa Pronto Soccorso e Medicina dUrgenza
Biochemia Medica | Year: 2013

Background: Early diagnosis is crucial for management of patients with suspected acute myocardial infarction (AMI). Among innovative and promising biomarkers, the recent interest raised on glycogen phosphorylase isoenzyme BB (GPBB) has prompted us to perform a meta-analysis of published studies. Materials and methods: A systematic electronic search was carried out on PubMed, Web of Science and Google Scholar, with no date restriction, to retrieve all articles that have investigated the early diagnostic performance of GPBB in patients with suspected AMI, and directly reported or allowed calculation of sensitivity and specificity. A meta-analysis of the reported sensitivity and specificity of each study and pooled area under the curve (AUC) was then performed by random effect approach. Heterogeneity was assessed by I-square statistics. Results: Eight studies were finally selected for analysis (941 subjects; 506 cases and 435 controls), with a high heterogeneity (I-squared, 86.3%). The resulting pooled estimates and 95% confidence interval were 0.854 (0.801-0.891) for sensitivity, 0.767 (0.713-0.815) for specificity, 0.826 (0.774--0.870) for negative predictive value, 0.802 (0.754-0.844) for positive predictive value, and 0.754 (0.602-0.907) for AUC. In those studies that have simultaneously assessed GPBB and a troponin immunoassay, the combination of these biomarkers did not significantly improve the performance of troponin alone. Conclusion: GPBB does not meet the current requirements for an efficient diagnosis of AMI when used as a stand-alone test, whereas its combination with troponin merits further investigation in larger trials. Source


Lippi G.,Unita Operativa Pronto Soccorso e Medicina dUrgenza | Cervellin G.,Unita Operativa Pronto Soccorso e Medicina dUrgenza
Clinical Chemistry and Laboratory Medicine | Year: 2014

The diagnosis of acute coronary syndrome (ACS) has challenged the minds of cardiologists, emergency physicians and laboratorists for decades. A major breakthrough has, however, occurred at the dawn of the third millennium, with development, commercialization and introduction into clinical practice of troponin immunoassays. A novel generation of these methods, conventionally defined as "high-sensitivity" (HS), has more recently emerged. These latest generation assays are characterized by improved analytical sensitivity, which would theoretically allow earlier and more efficient diagnosis of ACS. Despite the considerable amount of information gathered over the past few years about the clinical use of conventional and HS immunoassays, several doubts persist and - according to our personal perspective - the evidence that the latest generation methods would represent a real breakthrough in management of patients in short-stay units such as the emergency department is still an unresolved issue. Beside the mystifying nomenclature that characterizes several commercial tests, recent evidence suggests that the diagnostic performance of some contemporary sensitive methods would equal those of HS immunoassays for early diagnosis, serial assessment and even prognostication of patients. Conversely, the better diagnostic specificity of conventional methods may represent an advantage for triaging patients in overcrowded emergency departments. There is hence a tangible threat that the measurement of troponin with HS methods would become more or less an "expensive cholesterol of the third millennium", and this risk must be carefully considered in a world of limited resources. So, our answer to the question if we do really need HS troponin immunoassays in the emergency department is "maybe not". Source

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