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Error Rates Resulting From Anemia can be Corrected in Multiple Commonly Used Point-of-Care Glucometers

Mann, Elizabeth A. MS, RN; Salinas, Jose PhD; Pidcoke, Heather F. MD; Wolf, Steven E. MD; Holcomb, John B. MD; Wade, Charles E. PhD

The Journal of Trauma: Injury, Infection, and Critical Care: January 2008 - Volume 64 - Issue 1 - p 15-21
doi: 10.1097/TA.0b013e318160b9e4
Original Articles
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Background: A point-of-care (POC) glucometer (G1) used for critical care at our institution is inaccurate in the presence of low hematocrit (HCT) values. The purpose of this study was to analyze error rates of three additional POC glucometer brands and determine mathematical correction formulas for each.

Methods: Blood samples (n = 196) from a cohort of surgical, trauma, medical, cardiothoracic, and burn intensive care unit patients were tested on three commonly used POC glucometer brands (G2–G4). Results were compared with reference laboratory values, and correction compared with the validated formula for G1. A mathematical formula specific to each glucometer type was derived from glucose measurements, associated HCT values, and the degree of difference relative to laboratory results.

Results: POC glucometer results were consistently elevated compared with reference laboratory values. Glucometer error rates for HCT ≤ 25% ranged from 15.4% to 22.3% for the three types. Error rates for 25% < HCT < 34% ranged from 16.4% to 18.4%. A correction formula for each glucometer based on the natural log transformation of the HCT predicted reference values with a mean error rate of −0.54% ± 5.6% for G2, −0.6% ± 5.5% for G3, and 0.2% ± 8.0% for G4. Correction was similar to that previously established for G1 (−0.01% ± 4.8).

Conclusions: Significant error rates because of HCT effect were found in all glucometer models tested with accurate prediction of reference values with a simple mathematical formula.

From the US Army Institute of Surgical Research, Fort Sam Houston, Texas.

Submitted for publication September 27, 2007.

Accepted for publication October 31, 2007.

The opinions or assertions expressed herein are the private views of the authors and are not to be construed as official or as reflecting the views of the United States Department of the Army or the United States Department of Defense.

Supported by the National Institutes of Health (1 R01 GM06310-04) and the Technologies for Metabolic Monitoring (TMM)/Julia Weaver Fund, A Congressionally Directed Program Jointly Managed by the USA MRMC, NIH, NASA and the Juvenile Diabetes Research Foundation and Combat Casualty Care Division, United States Army Medical Research and Materiel Command.

Presented at the 66th Annual Meeting of the American Association for the Surgery of Trauma, September 27–29, 2007, Las Vegas, Nevada.

Address for reprints: Elizabeth A. Mann, MS, RN, US Army Institute of Surgical Research, 3400 Rawley E Chambers Ave, Fort Sam Houston, TX 78234; email: elizabeth.mann@us.amedd.army.mil.

© 2008 Lippincott Williams & Wilkins, Inc.