Pereira Telma C, Liu Yulin, Silverman Jan F
Department of Pathology and Laboratory Medicine, Allegheny General Hospital, Pittsburgh, PA, USA.
Am J Clin Pathol. 2004 Aug;122(2):201-5. doi: 10.1309/7NRW-7G68-4VEP-WPMR.
Analogous to critical values (CVs) in clinical pathology, occasional diagnoses in surgical pathology could require immediate contact of the physician to rapidly initiate treatment. However, there are no established CV guidelines in surgical pathology. We studied the incidence of CVs in surgical pathology by retrospective review of 2,659 surgical pathology reports and surveyed the perceptions of 5 clinicians and 11 pathologists about CVs in surgical pathology. We identified 13 CV cases (0.49%); 4 of the 13 reports documented phone calls to the clinician (most at least 1 day before final sign-out), and in 2 other reports the requisition included clinical history that implied previous knowledge of the diagnosis. The survey results indicated that for most diagnoses there was a range of opinions about whether immediate treatment was necessary and the need for a stat phone call. CVs occur in surgical pathology, but often there is no documented phone call in the surgical pathology report. Because there is little agreement about which diagnoses require a phone call and the degree of urgency, a consensus conference might prove useful for establishing surgical pathology CV guidelines and could represent a practice improvement.
与临床病理学中的临界值（CV）类似，手术病理学中的某些诊断可能需要医生立即联系以迅速开始治疗。然而，手术病理学中尚无既定的临界值指南。我们通过回顾2659份手术病理学报告研究了手术病理学中临界值的发生率，并调查了5名临床医生和11名病理学家对手术病理学中临界值的看法。我们确定了13例临界值病例（0.49%）；13份报告中有4份记录了给临床医生打电话的情况（大多数在最终签署报告前至少1天），另外2份报告中申请单包含的临床病史暗示之前已了解诊断情况。调查结果表明，对于大多数诊断，关于是否需要立即治疗以及是否需要紧急电话通知存在一系列不同意见。手术病理学中会出现临界值情况，但手术病理学报告中通常没有记录打电话的情况。由于对于哪些诊断需要打电话以及紧急程度几乎没有共识，召开一次共识会议可能有助于制定手术病理学临界值指南，并且可能代表一种实践改进。
