Clinical risk of using the Nova StatStrip glucose meter in a critically ill patient population: Analysis with the Surveillance and IDEA error grids
Date:
Introduction: Accurate glucose measurement in critically ill patients is paramount when implementing moderate or tight glycemic protocols. In 2014, the surveillance error grid was established in response to a survey of 206 diabetes expert physicians. This grid differs from those of Clarke and Parkes in that 15 color coded zones were developed with associated levels of clinical risk. An insulin dosing error grid (IDEA) was developed that expresses glucose error in units of the ‘size of error in insulin dose categories’ which is customizable for local insulin protocols for specific patient groups. The objective of this study was to compare application of the surveillance and IDEA error grids using critically ill patient glucose data from a multicentre international investigation.
Materials and Methods: Retrospective analysis of 1,815 paired glucose results (Nova Statstrip® versus the central laboratory glucose methods) from 1,698 critically ill patients (DuBois et al., 2017) were analyzed with the surveillance and IDEA error grids. The surveillance error grid (SEG) analysis was conducted using SEG software. For the IDEA grid, the effect of 0.5 mg/dL differences between methods on the size of insulin dose category error was determined by simulation using the protocol for critically ill patients (Karon et al, 2010). Patient data was plotted on the error grid to indicate the extent that observed glucose results are expected to affect changes of insulin dose. Results: With the surveillance error grid, 99.1% were within the assessable range, 97.6% indicated no clinical risk, 2.3% demonstrated slight (low risk) and 0.1% showed slight (high risk). Analysis with the IDEA grid indicated that 76.8% were within +/- 1 insulin dose categories; 99.2% within +/-2 dose categories (low risk). Conclusions: The surveillance error grid and the IDEA error grid both indicated there was low clinical risk with using the Nova Statstrip® glucose meters to determine insulin dose in this critically ill population.