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Rapid Diagnosis of Sepsis: Point-of-Care Testing, Nucleic Acid Testing, and the Value Model

Kost, Gerald J. MD, PhD*; Tran, Nam K. BS*; Louie, Richard F. BS*; Tang, Zuping MD*; Woodruff, Ashley A. BS*; Albertson, Timothy E. MD, PhD; Derlet, Robert W. MD; Azari, Rahman PhD§

Point of Care: The Journal of Near-Patient Testing & Technology: September 2003 - Volume 2 - Issue 3 - p 163-171
Original Articles

Unacceptable mortality rates and excessively high costs of sepsis can be attributed in part to delayed pathogen identification, poorly focused treatment, and unjustified antimicrobial use. Rapid diagnosis of pathogens, immediately focused antibiotics, and quick interruption of dysfunctional sepsis cascades could optimize clinical value. Value analysis constructs evidence-based hypotheses, called value propositions, that form a value model for the use of rapid diagnosis and point-of-care testing (POCT) in sepsis. Rapid diagnostic methods, such as nucleic acid testing (NAT), can assure fast therapeutic turnaround time. The authors applied NAT hypothetically to different scenarios for which they performed value analysis of patient and hospital costs and of medical outcomes. Value propositions were constructed for both adult and pediatric clinical situations. The authors conclude that rapid diagnosis by NAT can reduce the probability of complications, allow physicians to immediately focus treatment, and decrease both costs and mortality. Expected benefits for both pediatric and adult patients validate the need for continued NAT research and development of POCT for critically ill patients with sepsis.

From the *Point-of-Care Testing Center for Teaching and Research (POCT·CTR™), School of Medicine, University of California, Davis; Division of Pulmonary and Critical Care Medicine, and ‡Emergency Medicine, Department of Internal Medicine, UCD Health System; and §Statistics Department, University of California, Davis, California, USA.

Presented at the 19th International Symposium on Critical Care and Point-of-Care Testing, Monterey, CA, September 2002.

Reprints: Gerald J. Kost, MD, PhD, MS 506 Citadel Drive, Davis, CA (e-mail: gjkost@ucdavis.edu).

© 2003 Lippincott Williams & Wilkins, Inc.