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Agreement of Blood Gas Analysis Measurement Taken From Radial Artery and Capillary in Critically Ill Children
Blood gas analysis (BGA) still remains an important laboratory examination to diagnose and evaluate any critically ill patients. Its role is irreplaceable by other examination. There are many variations of technique and sampling location, including arterial, vein, or capillary system to obtain BGA, although it is known to have many complication and limitation. This clinical experiment aim towards agreement of BGA through different sampling between arterial and capillary system. A cross sectional study was conducted during July-August 2006 in PICU, Emergency Unit, and Pediatric Ward at Hasan Sadikin General Hospital, Bandung involving critically ill children >28 days-14 years of age without any alteration in peripheral perfusion, hypotension, and hypothermia. Blood sample was taken from both radial artery and capillary of each subject and sent to clinical pathology laboratory for BGA. The results were analyzed with Bland and Altman statistical method for assessing agreement between two methods of clinical measurement, and Cohen's coefficient agreement Kappa. Thirty subjects were included (25 male vs 5 female), mean age was 3 years old. Mostly suffered from bronchopneumonia (43%) and sepsis (23%) as the underlying disease. Based on Bland and Altman analysis method, there was agreement between this two sampling methods on all values of BGA with limits of agreement, respectively, -0.088 and +0.06, -5.72 and +3.342, -23.98 and +37.74, -4.833 and + 2.459, -4.163 and +2.649, -9.801 and +8.835. From Cohen's Kappa we found a good agreement on the result of blood gas analysis between this two sampling methods. Capillary blood gas measurement is a very useful alternative to arterial blood gas sampling. We recommend its use on critically ill children with good perfusion to reduce the risk of complication and more comfort to the patients.
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