McClain Colt M, Owings Richard, Bornhorst Joshua A
Department of Pathology, Vanderbilt University, Nashville, TN, 37232, USA.
J Pathol Inform. 2011;2:53. doi: 10.4103/2153-3539.91131. Epub 2011 Dec 26.
Critical values are reported to clinicians when laboratory values are life threatening and require immediate attention. To date no definitive critical value limit recommendations have been produced regarding therapeutic drug monitoring. Some laboratories choose to publish critical value lists online. These publicly available values may be accessed and potentially utilized by laboratory staff, patient care providers, and patients.
A web-based search of laboratories associated with the Accreditation Council for Graduate Medical Education pathology residency programs was initiated to determine which therapeutic drugs had critical values and to examine the degree of variation in published critical values for these institutions.
Of the 107 institutions with university-based pathology training programs, 36 had published critical values online for review. Thirteen therapeutic drugs were investigated and the number of institutions reporting critical value limits for the drug, as well as the median, range, standard deviation, and the coefficient of variation of critical value concentration limits for each drug were determined. A number of the online critical value limits were deemed to be erroneous, most likely due to incorrectly listed units of measurement.
There was a large degree of heterogeneity with regard to the chosen critical value limits for therapeutic drugs. This wide variance in critical values appears to be greater than that observed in interassay proficiency testing. Institutions should reexamine the rationale for their current critical value parameters and ensure that critical value limits and associated units are accurately published online.
当实验室检查结果危及生命且需要立即关注时，会向临床医生报告危急值。迄今为止，尚未就治疗药物监测制定明确的危急值界限建议。一些实验室选择在网上公布危急值清单。实验室工作人员、患者护理提供者和患者均可访问并可能利用这些公开可用的值。
对与毕业后医学教育认证委员会病理学住院医师培训项目相关的实验室进行基于网络的搜索，以确定哪些治疗药物有危急值，并检查这些机构公布的危急值的差异程度。
在107个设有大学病理学培训项目的机构中，有36个在网上公布了危急值以供查阅。对13种治疗药物进行了调查，确定了报告该药物危急值界限的机构数量，以及每种药物危急值浓度界限的中位数、范围、标准差和变异系数。许多在线危急值界限被认为是错误的，很可能是由于测量单位列出错误。
治疗药物的危急值界限选择存在很大程度的异质性。危急值的这种广泛差异似乎大于在批间能力验证中观察到的差异。各机构应重新审视其当前危急值参数的依据，并确保危急值界限及相关单位在网上准确公布。
