Schapkaitz E, Levy B
Department of Molecular Medicine and Haematology, University of Witwatersrand Medical School, Johannesburg, South Africa.
Ican practice, Life Glynnwood and Netcare Rosebank intensive care units, Johannesburg, South Africa.
Int J Lab Hematol. 2015 Oct;37(5):620-5. doi: 10.1111/ijlh.12373. Epub 2015 Apr 28.
Critical value policies are used by clinical laboratories to decide when to notify caregivers of life-threatening results. There, however, remains much debate regarding which tests should be included in critical value lists and clinically relevant limits.
An electronic survey was designed to determine the critical value policies of specialists for haematology tests in South African intensive care units. Data collected included a demographic component, critical value policies and critical value reporting.
There were 68 respondents who represented a range of specialists from different disciplines. Four key critical values were identified, namely white cell count (WCC), haemoglobin, platelet count and international normalised ratio (INR). Median low and high adult and paediatric critical limits for the most frequently listed tests were as follows: haemoglobin <7 and >20 g/dL, platelet count <50 and >1000 × 10(9) /L, WCC < 2 and >20 × 10(9) /L and INR > 4. Specific critical limits for neonates were reported by 20 of the respondents. Of the respondents, 95.92% indicated that it was important to be contacted with first-time critical results and approximately half for repeat critical values. The majority preferred that the person notified of the critical value be the caregiver directly involved with the patient's care.
It is important for critical value policies to be reviewed by each discipline to ensure cut-offs are clinically relevant.
临床实验室采用危急值政策来决定何时将危及生命的检查结果通知医护人员。然而，关于哪些检查应纳入危急值清单以及临床相关限值仍存在诸多争议。
设计了一项电子调查，以确定南非重症监护病房血液学检查专家的危急值政策。收集的数据包括人口统计学信息、危急值政策和危急值报告。
68名受访者代表了不同学科的一系列专家。确定了四个关键危急值，即白细胞计数（WCC）、血红蛋白、血小板计数和国际标准化比值（INR）。最常列出的检查项目中，成人和儿童危急值的低限和高限中位数如下：血红蛋白<7和>20 g/dL，血小板计数<50和>1000×10⁹/L，WCC<2和>20×10⁹/L，INR>4。20名受访者报告了新生儿的特定危急值限值。在受访者中，95.92%表示首次出现危急结果时接到通知很重要，约一半受访者认为重复危急值时接到通知也很重要。大多数人倾向于将危急值通知直接参与患者护理的医护人员。
各学科审查危急值政策以确保临界值具有临床相关性非常重要。
