Diagnosis of acute serious illness: the role of point-of-care technologies

Abstract

Access to rapid diagnostic information is a core value of point-of-care (POC) technology. This is particularly relevant in acute, emergency, and critical care settings where diagnostic speed and precision directly guide the management of patients with potentially life-threatening conditions. Many POC diagnostics described in the literature, however, remain largely unproven and have yet to enter the market entirely. Only a few have traversed the translation and commercialization pathways to reach widespread clinical adoption. Moreover, even technologies that have successfully translated to the patient bedside still frequently lack an evidence base showing improvement of clinical outcomes. In this review, we present aspects of diagnosis of acute life-threatening diseases and describe the potential role of POC technologies, emphasizing the available evidence of clinical outcomes. Finally, we discuss what is needed to identify clinically meaningful new technologies and translate them toward the long-promised goal of better health through rapid POC diagnosis.

Keywords: Acute care; Critical care; Diagnostics; Microsystems; Outcomes; Point-of-care.

Figure 1

An organ-systems overview of major critical care problems and corresponding biomarkers. Few markers—including troponin, viscoelastography, and respiratory pathogen detection—have robust evidence for the impact of a POC assay on outcomes in clinical care. The majority of biomarkers, while important in clinical management, have either not been adequately investigated or have failed to show evidence of meaningful impact when comparing POC measurement to usual care. POC, point-of-care; ALT: alanine aminotransferase; AST: aspartate aminotransferase; PT: prothrombin time; INR: international normalized ratio; ABG: arterial blood gas; aPTT: activated partial thromboplastin time.