Dr. Wu Gang of Nanfang Hospital Highlights the Significant Value of POCT in Trauma Centers

Establishing an effective, rational, and efficient operational mechanism is a key focus and challenge for trauma centers. Point-of-care testing (POCT) devices, capable of rapid detection and quick result acquisition, are essential equipment in trauma centers. They help clinicians seize precious time for emergency care and have been widely adopted in trauma centers.

November 13–14, 2020 – The “2020 China POCT Annual Conference,” co-hosted by the Point-of-Care Testing (POCT) Branch of the China Association for Medical Device Industry and the People’s Government of Jiangbei District, Chongqing Municipality, was held in Chongqing. Under the slogan “BeiDou + 5G: Building the Dream of China’s POCT” and themed “Precision Epidemic Control, Health for All,” the conference featured discussions on topics including POCT applications, nanozymes and POCT, ultrasound testing, POCT and primary healthcare, and POCT and the Six Major Centers. The event comprised a plenary session, thirteen specialized academic forums, and an exhibition showcasing corporate products.

On the 14th, at the POCT and Six Major Centers Subforum, Dr. Wu Gang, Associate Chief Physician of the Emergency Department at Nanfang Hospital, Southern Medical University, delivered a presentation titled “Application of POCT in Trauma Centers.” VCBeat has compiled his key insights.

A Trauma Center is a diagnosis and treatment hub dedicated to trauma care, jointly composed of the Emergency Department, Orthopedics, Neurosurgery, General Surgery, Cardiothoracic Surgery, Urology, Otorhinolaryngology (ENT), Interventional Radiology, Anesthesiology, Medical Imaging, and Blood Transfusion departments. It provides a prioritized “green channel” for emergency resuscitation of critically injured patients, thereby standardizing and enhancing the quality of trauma care.

With rising medical costs, the growing trend toward personalized medicine, and physicians’ increasing demand for rapid diagnostic results, point-of-care testing (POCT) has emerged. POCT is a testing approach that enables on-site, rapid result generation using portable analytical instruments and配套 reagents. It does not require complex infrastructure or conditions, eliminates the need for intricate specimen pretreatment, and supports continuous monitoring. These characteristics make POCT particularly well-suited for trauma centers, allowing clinicians to perform rapid testing and continuous monitoring at the scene, in ambulances, and in intensive care units (ICUs).

Director Wu Gang illustrated the significant value of POCT devices, such as point-of-care ultrasound and thromboelastography analyzers, in trauma centers by citing several typical application scenarios.

Blunt Thoracoabdominal Trauma refers to conditions characterized by intact thoracic and abdominal walls resulting from blunt injury, which may be accompanied by visceral damage. As it is often associated with injuries to other regions, such as traumatic brain injury and fractures, the symptoms and signs of this condition can be masked, making definitive diagnosis challenging. Missed diagnoses and delayed diagnosis of intrathoracic and intra-abdominal injuries are among the major causes of preventable death in patients with severe trauma. Therefore, during diagnosis and treatment, in addition to addressing overt injuries, particular attention should be paid to occult injuries.

Bedside Focused Assessment with Sonography for Trauma (FAST) is a portable ultrasound examination performed by clinicians at the patient’s bedside to facilitate rapid diagnostic assessment and guide procedures, serving as a critical tool for detecting occult trauma.

FAST demonstrates exceptionally high sensitivity for detecting free fluid and gas within the thoracic and abdominal cavities in patients with closed chest and abdominal trauma. The examination time ranges from 1.5 to 6 minutes, which is significantly shorter than that of CT scans. This modality enables clinicians to rapidly ascertain the specific location of injury and the mechanism of trauma, thereby minimizing the risk of missed or misdiagnosis. Furthermore, it facilitates dynamic bedside re-evaluation, avoiding potential secondary injuries associated with patient transport.

FAST can also be used in cardiopulmonary resuscitation (CPR). After 6 minutes of CPR, portable ultrasound examination is performed under the xiphoid process during the 10-second pause every 2 minutes of chest compressions, to quickly identify or rule out the causes of cardiac arrest.

In cardiopulmonary resuscitation (CPR) for trauma patients, the Focused Assessment with Sonography for Trauma (FAST) exam can rapidly identify reversible causes such as hemorrhagic shock, tension pneumothorax, and cardiac tamponade; assess mechanical cardiac activity and prognosis; differentiate between pseudo- and true pulseless electrical activity (PEA); accurately detect ventricular fibrillation and confirm whether myocardial activity has completely ceased. It is also useful for monitoring organ function post-resuscitation and assisting with various procedures during resuscitation, such as guiding endotracheal intubation placement and establishing vascular access.

Rational Blood Transfusion Is Crucial. For patients with massive hemorrhage due to trauma, early correction of hypovolemia is essential to prevent tissue perfusion from declining to an irreversible level. However, blind massive transfusion may lead to complications such as acidosis and hypocalcemia, resulting in coagulation disorders, which in turn increase the demand for further transfusions and may even lead to death.

Thromboelastography (TEG) is a commonly used point-of-care testing (POCT) device in blood transfusion departments. The dynamic coagulation curve recorded by TEG enables real-time analysis of the entire process of clot formation and fibrinolysis, measures the time to initial clot formation, and assesses clot stability and strength over time. It can also directly detect hyperfibrinolysis, serving as an indicator of the dynamic changes in blood coagulation.

The rapid, multifaceted information provided by point-of-care TEG enables clinicians to devise more rational transfusion strategies for patients with acute injuries, thereby alleviating the burden on blood product supplies and reducing the incidence of transfusion-associated complications.

Additionally, systemic coagulopathy involving multiple factors may occur after major trauma, known as trauma-induced coagulopathy (TIC). Since reliance on standard serial laboratory tests fails to correct coagulopathy in a timely manner, it is recommended that trauma patients with coagulopathy be managed using point-of-care testing (POCT) (such as thromboelastography and platelet monitoring) and clinical scoring systems (based on the mechanism and severity of trauma, the patient’s hemodynamic status, and evidence of active bleeding) to guide treatment.

Tissue hypoperfusion in patients with hypovolemic shock due to hemorrhage can lead to metabolic (lactic) acidosis. Studies have shown that blood lactate measurement, particularly dynamic lactate monitoring, is a useful indicator for metabolic monitoring in critically ill patients, and can be used to indicate the severity of the disease and objectively assess prognosis.

Director Wu Gang stated that POCT will inevitably evolve toward rapid, precise, user-friendly, portable, and continuously monitorable solutions. Its technical capabilities, test menus, and application scope will continue to expand and improve, better aligning with the actual clinical needs of trauma centers and driving the development of trauma care in China.

However, currentlyPOCT still faces challenges such as high costs per test, an imperfect quality control system, chaotic result reporting formats with no unified standard, and low levels of informatization. Director Wu Gang hopes that policy-level documents will be introduced to regulate the development of the POCT industry, encouraging manufacturers to continuously innovate and promote the advancement of POCT information management systems, thereby reducing testing costs and improving accuracy.