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Evaluation of the Test-mate ChE (Cholinesterase) Field Kit in Acute Organophosphorus Poisoning - 18/11/11

Doi : 10.1016/j.annemergmed.2011.07.014 
Bishan N. Rajapakse, MBChB a, b, g, , Horst Thiermann, MD c, Peter Eyer, MD d, Franz Worek, MD, PhD c, Steven J. Bowe, M Med Stat, PhD e, Andrew H. Dawson, MBBS, FRACP a, h, Nicholas A. Buckley, MD, FRACP a, b, f
a South Asian Clinical Toxicology Research Collaboration, Peradeniya, Sri Lanka 
b ANU Medical School, Australian National University, Canberra, Australia 
c Bundeswehr Institute of Pharmacology and Toxicology, Munich, Germany 
d Walther-Straub Institute of Pharmacology and Toxicology, Ludwig-Maximilians University, Munich, Germany 
e Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Australia 
f University of New South Wales, Sydney, Australia 
g Emergency Department, Prince of Wales Hospital, Sydney, Australia 
h Royal Prince Alfred Hospital, Sydney, Australia 

Address for correspondence: Bishan Nishantha Rajapakse, MBChB

Résumé

Study objective

Measurement of acetylcholinesterase (AChE) is recommended in the management of organophosphorus poisoning, which results in 200,000 deaths worldwide annually. The Test-mate ChE 400 is a portable field kit designed for detecting occupational organophosphorus exposure that measures RBC AChE and plasma cholinesterase (PChE) within 4 minutes. We evaluate Test-mate against a reference laboratory test in patients with acute organophosphorus self-poisoning.

Methods

This was a cross-sectional comparison study of 14 patients with acute organophosphorus poisoning between May 2007 and June 2008. RBC AChE and PChE were measured in 96 and 91 samples, respectively, with the Test-mate ChE field kit and compared with a reference laboratory, using the limits of agreement method (Bland and Altman), κ statistics, and Spearman's correlation coefficients.

Results

There was good agreement between the Test-mate ChE and the reference laboratory for RBC AChE. The mean difference (Test-mate–reference) was –0.62 U/g hemoglobin, 95% limits of agreement –10.84 to 9.59 U/g hemoglobin. Good agreement was also observed between the categories of mild, moderate, and severe RBC AChE inhibition (weighted κ 0.85; 95% confidence interval [CI] 0.83 to 0.87). Measurement of PChE also showed good agreement, with a mean difference (Test-mate–reference) of +0.06 U/mL blood, 95% limits of agreement –0.41 to 0.53 U/mL blood. Spearman's correlation coefficients were 0.87 (95% CI 0.81 to 0.91) for RBC AChE and 0.76 (95% CI 0.66 to 0.84) for PChE. Analysis for within-subject correlation of subjects did not change the limits of agreement.

Conclusion

The Test-mate ChE field kit reliably provides rapid measurement of RBC AChE in acute organophosphorus poisoning.

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 Please see page 560 for the Editor's Capsule Summary of this article.
 A podcast for this article is available at www.annemergmed.com.
 Supervising editor: Richard C. Dart, MD, PhD
 Author contributions: BNR and NAB conceived the study and designed the protocol. AHD and NAB obtained research funding. BNR and AHD undertook recruitment of participating centers. BNR contributed to the collection of the clinical data, and BNR, HT, FW contributed to collection of the laboratory data. All authors were involved in the data analysis and interpretation. SJB provided statistical advice about the study design and data analysis. BNR drafted the article, and all authors contributed substantially in its revision. BNR takes responsibility for the paper as a whole.
 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. This research was funded by an international collaborative research grant from the Wellcome Trust/National Health and Medical Research Council, Australia (GR071669). The Wellcome Trust had no involvement in the design and conduct of the study; in the collection, management, analysis, and interpretation of the data; or in the preparation, review, or approval of the article.


© 2011  American College of Emergency Physicians. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 58 - N° 6

P. 559 - décembre 2011 Retour au numéro
Article précédent Article précédent
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