Technology in the trenches: The state of point-of-care testing

Key Points

In the late 1980s, pediatricians were introduced to point-of-care tests (POCTs) to expedite diagnosis and facilitate treatment of our patients. This article presents a brief overview of POCTs in pediatric practice and offers guidance regarding which POCT would best suit your practice and practice style.

Many years ago, it was customary for pediatricians to maintain a small office clinical lab that included a hematocrit spinner as well as an incubator used for throat and urine cultures. Urine dipstick testing was done as well, and very busy pediatric offices also performed complete blood counts (CBCs) and serum chemistries using devices designed specifically for medical offices.

In the mid-1980s, pediatricians routinely began performing rapid strep tests, and eventually a typical office lab "rapid test" repertoire grew to include fecal occult blood testing, urine dipstick urinalysis, mononucleosis testing, urine pregnancy tests, and photometric assays for quantitative hemoglobin determination.

Today . . .

Most pediatric offices now perform tests in the CLIA '88 "waived" category, which are devices and tests cleared by the US Food and Drug Administration (FDA) that are so simple to use that they make erroneous results unlikely, pose no serious risk to patients if the test were performed incorrectly, or are FDA cleared for home use (see, "Some CLIA '88 Waived Tests").¹

Waived POCTs have grown in number and include more than 70 different tests. There are considerations involved in developing and maintaining a top-notch office laboratory-including deciding which tests you should be performing and understanding "real world" POCT "accuracy."