Point-of-care peripheral venous blood gas in the elderly demographic in the emergency department; a pilot study

Pouryahya P, Luo J, Graudins A, Meyer A McR. Point-of-care peripheral venous blood gas in the elderly demographic in the emergency department; a pilot study. Med Emergency, MJEM 2019; 27
DOI 10.26738/MJEM.2017/MJEM27.2019/PP.OAE.270618

Keywords: elderly, emergency department, point of care testing, re-presentation, venous blood gas

  • Authors’ affiliation
  • Article history/info
  • Conflict of interest statement

Corresponding author: Pourya POURYAHYA, MD

Casey Hospital, Department of Emergency medicine,

62-70 Kangan drive, Berwick, Victoria 3806, Australia

pourya.pouryahya@monashhealth.org

Pouryahya P,  MD1,2,3, Luo J, MD3 , Graudins A, MD2,3, Meyer A McR, MD1,2,3 

1. Casey hospital, Emergency Department, Program of Emergency Medicine, Monash Health, Melbourne, Australia

2. Monash Emergency Research Collaborative, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia

3. Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia

Category: original article

Received: May 2, 2018

Revised: June 6, 2018

Accepted: June 27, 2018

There is no conflict of interest to declare

ABSTRACT

Background: The peripheral venous blood gas (PVBG) has gained popularity over the arterial blood gas and electrolytes-urea-creatinine panel in non-critical situations in the emergency department. Despite its convenience and rapid result return, it is costly and potentially over-utilized.

Aim: To assess the utility of point of care (POC) PVBG samples in predicting re-presentation of elderly patients (over the age of 65) to the emergency department within 72 hours, who were discharged without inpatient admission directly from ED.

Method: A retrospective audit was performed on patients of the above demographic, who presented to three Monash Health EDs between Jan 2011 and Oct 2015 and had a single POCPVBG sample taken. The individual POCPVBG values were compared between those who re-presented within 72 hours to those who did not, as were demographic data.

Results: In the 723 eligible cases in the study period, 127 (18%) re-presented within 72 hours whilst 596 (82%) did not. The median ages were similar (76, 77) as was proportion of males (50%, 51%). The most common presenting complaints in both groups were shortness of breath and abdominal pain. Categorical analysis showed a statistically significant association between low base excess (OR 2.5, 95%CI 1.2-4.9) and low potassium (OR 2.1, 95%CI 1.2-3.8) with re-presentation. However, these results had unclear clinical significance; the sensitivity and likelihood ratios for each were 16% and 2.2 and 15% and 1.9.

Conclusion: The PVBG may have some utility as a predictor of re-presentation in non-critical presentations of elderly patients to the ED. However, the role of a single POCPVBG sample in assessment of such patients remains unclear, and further research and guidelines need to be established to avoid over-utilization