Improving the accuracy of chloride measurements through participation in regular external quality assessment programme |
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| Institution: | 1. Center for Advanced Studies and Technology (C.A.S.T.), \"G. d''Annunzio\" University of Chieti-Pescara, Via Luigi Polacchi 11, Chieti, I-66100, Italy;2. Department of Physics, Università Degli Studi di Milano, Via Celoria 16, Milano, I-20133, Italy;3. LASA, Department of Physics, Università Degli Studi di Milano and INFN-Milano, Via F.lli Cervi 201, Segrate, MI, I-20090, Italy;4. Institute of Clinical Immunotherapy and Advanced Biological Treatments, Piazza Pierangeli 1, Pescara, Rectorate of Leonardo da Vinci Telematic University, Largo San Rocco 11 Torrevecchia Teatina, CH, Italy;5. Department of Medicine and Aging Sciences, \"G. d''Annunzio\" University of Chieti-Pescara, via Luigi Polacchi 11, Chieti, I-66100, Italy;1. Department of Chemical, Biological, Pharmaceutical, and Environmental Sciences, University of Messina, 98166, Messina, Italy;2. Department of Human Pathology in Adult and Developmental Age, University of Messina, 98125, Messina, Italy;3. Experimental Zooprophylactic Institute of Sicily “A. Mirri”, Palermo, Italy;4. Bayramiç Vocational School, Çanakkale Onsekiz Mart University, Çanakkale, 17100, Turkey;5. Department of Veterinary Sciences, Polo Universitario dell’Annunziata, 98168, Messina, Italy;1. Department of Physiology, School of Sport Sciences, University of Extremadura, Avenida de la Universidad s/n, 10003 Cáceres, Extremadura, Spain;2. Department of Sport Science, Faculty of Education, Pontifical University of Salamanca, C/Henry Collet, 52–70, CP: 37007 Salamanca, Spain;3. Movement, Brain and Health (MOBhe) Research Group, Center of Higher Education Alberta Giménez, affiliated to Comillas Pontifical University, Costa de Saragossa 16, 07013 Palma, Mallorca, Balearic Islands, Spain;4. Faculty of Language and Education, University of Nebrija, Campus La Berzosa, Calle del Hostal, 28248, Hoyo de Manzanares, Madrid, Spain;1. Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, and Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, PR China;2. Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, Guangdong Province, 518051, PR China;1. Medical Biomaterial Research Center (MBRC), Tehran University of Medical Sciences, Tehran, Iran;2. Department of Toxicology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran;1. Department of Public Health, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic;2. Department of Respiratory Diseases, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic;3. Research Centre for Toxic Compounds in the Environment (RECETOX), Faculty of Science, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic;4. Institute of Analytical Chemistry of the Czech Academy of Sciences, Veveří 97, 602 00, Brno, Czech Republic;5. Institute of Laboratory Research on Geomaterials, Faculty of Natural Sciences, Comenius University in Bratislava, Slovakia |
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| Abstract: | BackgroundA chloride test is an integral part of a basic metabolic panel that is essential for the assessment of a patient’s acid-base and electrolyte status. While many methods are available commercially for the routine measurement of chloride, there is a need to address the accuracy and variability among the measurement results, especially with the prevalence of patients seeking treatment across different healthcare providers for alternative opinions.MethodA method based on sector field inductively coupled plasma isotope dilution mass spectrometry (SF-ICP-IDMS) was developed for the measurement of chloride in human serum. The SF-ICP-IDMS method was then used to assign the target values in the Health Sciences Authority (HSA) External Quality Assessment (EQA) Programme to evaluate the results of chloride test from participating clinical laboratories.ResultsThe accuracy of the measurements was evaluated by comparing the results with the certified values of Electrolytes in Frozen Human Serum Certified Reference Materials (SRM 956c and SRM 956d) from the National Institute of Standards and Technology (NIST) at different chloride concentration levels. Over a five-year period from 2014–2018, the number of clinical laboratories which participated in the EQA Programme increased from 23 to 33. Comparison of robust means from the laboratories’ results with our assigned target values revealed a reduction in relative deviation over time. The relationship between the deviation of each brand of clinical analysers and the chloride levels was established, where a larger deviation was uncovered at low chloride concentration. The SF-ICP-IDMS method was further demonstrated to be comparable with methods used by other metrology institutes in an international comparison organised by HSA under the auspice of the Consultative Committee for Amount of Substance – Metrology in Chemistry and Biology (CCQM).ConclusionThe use of metrologically traceable assigned target values enabled the study of method biasness from a small pool of dataset in each of the four brands of clinical analysers in HSA EQA Programme. This work underscores the need to improve the accuracy of chloride measurements by regular participation in an accuracy-based EQA Programme. |
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| Keywords: | Chloride Human serum Isotope-dilution Mass spectrometry External quality assessment Method bias Reference value |
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