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Open Access Research article

Effect of acetylcholinesterase (AChE) point-of-care testing in OP poisoning on knowledge, attitudes and practices of treating physicians in Sri Lanka

Bishan N Rajapakse12*, Teresa Neeman3 and Nicholas A Buckley24

Author Affiliations

1 College of Medicine, Biology and Environment, Australian National University, Canberra, Australia

2 South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka

3 Statistical Consulting Unit, Australia National University, Canberra, Australia

4 Professorial Medical Unit, Prince of Wales Hospital clinical school, Avoca St, Sydney, Australia

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BMC Health Services Research 2014, 14:104  doi:10.1186/1472-6963-14-104

Published: 4 March 2014

Abstract

Background

Toxicology and Emergency medicine textbooks recommend measurement of acetylcholinesterase (AChE) in all symptomatic cases of organophosphorus (OP) poisoning but laboratory facilities are limited in rural Asia. The accuracy of point-of-care (POC) acetylcholinesterase testing has been demonstrated but it remains to be shown whether results would be valued by clinicians. This study aims to assess the effect of seeing AChE POC test results on the knowledge, attitudes and practices of doctors who frequently manage OP poisoning.

Methods

We surveyed 23 clinicians, who had different levels of exposure to seeing AChE levels in OP poisoned patients, on a) knowledge of OP poisoning and biomarker interpretation, b) attitudes towards AChE in guiding poison management, oxime therapy and discharge decisions, and c) practices of ordering AChE in poisoning scenarios.

Results

An overall high proportion of doctors valued the test (68-89%). However, we paradoxically found that doctors who were more experienced in seeing AChE results valued the test less. Lower proportions valued the test in guidance of acute poisoning management (50%, p = 0.015) and guidance of oxime therapy (25%, p = 0.008), and it was apparent it would not generally be used to facilitate early discharge. The highest proportion of respondents valued it on admission (p < 0.001). A lack of correlation of test results with the clinical picture, and a perception that the test was a waste of money when compared to clinical observation alone were also comments raised by some of the respondents.

Greater experience with seeing AChE test results was associated with increased knowledge (p = 0.034). However, a disproportionate lack of knowledge on interpretation of biomarkers and the pharmacology of oxime therapy (12-50%) was noted, when compared with knowledge on the mechanism of OP poisoning and management (78-90%).

Conclusions

Our findings suggest an AChE POC test may not be valued by rural doctors. The practical use of AChE in OP poisoning management is complex, and a poor understanding of how to interpret test results may have affected its perceived utility. Future research should evaluate the impact of providing both AChE and training in interpretation on clinicians’ attitudes and practice.

Keywords:
Point-of-care testing; Rural emergency medicine; Resource limited setting; Asia; Laboratory technology; Physician attitudes; Organophosphorus poisoning; Cholinesterase measurement; Oxime therapy