Maastricht University, School of Public Health and Primary Care (CAPHRI), Department of General Practice, Maastricht, The Netherlands.
Scand J Prim Health Care. 2010 Mar;28(1):18-23. doi: 10.3109/02813430903281758.
Laboratory tests are ordered on a daily basis, even though disease probability is often very low. Abnormal results, especially mildly abnormal results, can be difficult to interpret in these circumstances. Further insights into the occurrence of abnormalities can help improve rational test ordering and test interpretation. The objective was therefore to examine the frequency of mildly and markedly abnormal results and their relationship with physicians' reasons for ordering tests.
Prospective study. Participants. A total of 87 primary care physicians in the Netherlands collected data on 1775 patients.
The physicians recorded the reason for ordering the tests, the most probable diagnosis and the pretest probability. The laboratories' reference values and specified "action limits" were used to assess the number of abnormal results and markedly abnormal results, respectively.
Laboratory results were received for 1621 patients and 15,603 tests were reported (mean 9.6). The proportion of abnormal test results increased with increasing pretest probability (from 13.9% to 34.7%) and was 13.4% for tests ordered to reassure the patient and 13.3% for psychosocial diagnoses. The proportion of patients with at least one abnormal test result was high: 53.1% for tests ordered to reassure and 57.7% in patients with low pretest probability. Corresponding values for a marked abnormality were 11.1% and 12.4%, respectively.
Abnormal laboratory test results were frequent, even when pretest probability was low. Physicians should therefore carefully consider when tests are necessary. Future research could explore physicians' interpretation of test results and its impact on diagnosis and management.
尽管疾病的概率通常很低，但实验室检测每天都在进行。在这种情况下，解释轻度异常和明显异常的结果可能具有挑战性。进一步了解异常情况的发生可以帮助改善合理的检测顺序和检测解释。因此，本研究旨在检查轻度和明显异常结果的频率及其与医生检测原因的关系。
前瞻性研究。参与者：荷兰共有 87 名初级保健医生收集了 1775 名患者的数据。
医生记录了检测的原因、最可能的诊断和检测前的概率。实验室的参考值和指定的“行动限制”用于评估异常结果和明显异常结果的数量。
收到了 1621 名患者的实验室结果和 15603 项检测报告（平均 9.6 项）。异常检测结果的比例随着检测前概率的增加而增加（从 13.9%增加到 34.7%），用于安抚患者的检测的异常率为 13.4%，用于心理社会诊断的检测的异常率为 13.3%。至少有一项异常检测结果的患者比例很高：用于安抚患者的检测的异常率为 53.1%，检测前概率低的患者的异常率为 57.7%。相应的明显异常的比例分别为 11.1%和 12.4%。
即使检测前的概率很低，异常的实验室检测结果也很常见。因此，医生应仔细考虑何时需要进行检测。未来的研究可以探索医生对检测结果的解释及其对诊断和管理的影响。
