SR: poor quality evidence on outcomes of lactate point-of-care testing in patients with suspected sepsis

Référence

Morris E, McCartney D, Lasserson D, Van den Bruel A, Fisher R, Hayward G. Point-of-care lactate testing for sepsis at presentation to health care: a systematic review of patient outcomes. Br J Gen Pract 2017;67(665):e859-e870.

Sommaire

These authors searched multiple databases to identify studies that evaluated patients who presented to "first-assessment" settings (eg, community-based settings, emergency departments, and so forth) for the evaluation of serious bacterial infections. The studies had to compare POC lactate testing with usual care and had to include patient outcomes such as mortality, length of stay, time to treatment. Two authors independently assessed each study for the inclusion criteria (they ultimately included 8 studies with 3063 patients), and then assessed the the quality of each included study. A third reviewer adjudicated disagreements. The authors don't describe attempts to find unpublished data nor did they describe the potential for publication bias. Although they initially wanted to evaluate studies in primary care, they found none, so they looked at studies in other settings (7 in emergency departments and 1 in an aeromedical unit; 1346 patients evaluated by POC testing and 1717 control patients). Two studies used the same cohort but reported different outcomes. Three studies were before-and-after and 5 were cohort studies. There were no randomized trials. All of the studies had areas of moderate to serious risk of bias (confounding, selection, outcome measurement, reporting, and so forth) and were judged to be of overall moderate to serious risk of bias. The authors wisely chose to not pool data because of differences in methods and sampling of patients. Three of 6 studies found a statistically significant association between POC testing and decreased in-hospital mortality. Two studies reported that patients with POC testing received intravenous fluids faster than control patients. Three studies reported on the time to receipt of antibiotics: no overall difference in time, but a small increase in the proportion of those receiving antibiotics within 1 hour or 3 hours. Two studies reported on hospital length of stay: Patients who received POC testing spent approximately 1 day less in the hospital.