Sudarmana Aryanto, Monagle Paul
Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
Haematology Research, The Murdoch Children's Research Institute, Parkville, Victoria, Australia.
J Paediatr Child Health. 2015 Oct;51(10):1017-22. doi: 10.1111/jpc.12917. Epub 2015 May 15.
The association between inherited thrombophilia and thrombotic disease in children is unclear. As a result, whether expensive thrombophilia tests are indicated in children is a contentious issue. This retrospective study aimed to assess the appropriateness of thrombophilia testing and the associated cost of inappropriate testing at a tertiary paediatric hospital.
We conducted a search for thrombophilia tests ordered at the Royal Children's Hospital between 1 January 2011 and 31 December 2013. Using pathology and clinical records, we collected data relating to demographics, clinical data, indications, requesting departments and impact on patient management.
Over the 3-year period, 3867 tests were ordered for 613 patients costing the hospital $102 579. Tests were most commonly ordered by gastroenterology on patients receiving liver transplants, by neurology as part of the stroke protocol, and by cardiology and cardiac surgery for patients anticoagulated on heparin infusions. Testing for thrombosis-related indications was relatively uncommon. Thrombophilia testing only directly affected management in one-third of patients. Overall, 70% of thrombophilia tests ordered were considered appropriate. However, some departments were found to have rates of inappropriate testing in excess of 50%.
With improvements in thrombophilia testing practices at the Royal Children's Hospital AU$29 645.40 could be saved over 3 years. While there are improvements to be made in this area, in the overall context of the hospital's pathology testing budget, review of other areas such as inappropriate use of low-cost, high-volume tests may be of greater value in reducing the cost of pathology testing.
儿童遗传性易栓症与血栓形成性疾病之间的关联尚不清楚。因此，儿童是否需要进行昂贵的易栓症检测是一个有争议的问题。这项回顾性研究旨在评估一家三级儿科医院进行易栓症检测的适宜性以及不当检测的相关成本。
我们检索了2011年1月1日至2013年12月31日期间在皇家儿童医院进行的易栓症检测。利用病理和临床记录，我们收集了有关人口统计学、临床数据、检测指征、申请科室以及对患者管理影响的数据。
在这3年期间，为613名患者进行了3867次检测，医院花费102579美元。检测最常见于胃肠病科对接受肝移植的患者、神经科作为中风诊疗方案的一部分、以及心脏病科和心脏外科对接受肝素输注抗凝的患者。针对血栓形成相关指征的检测相对较少见。易栓症检测仅直接影响了三分之一患者的管理。总体而言，所进行的易栓症检测中有70%被认为是适宜的。然而，发现一些科室的不当检测率超过了50%。
随着皇家儿童医院易栓症检测实践的改进，3年内可节省29645.40澳元。虽然该领域仍有改进空间，但在医院病理检测预算的整体背景下，审查其他领域，如低成本、高用量检测的不当使用，可能对降低病理检测成本更有价值。
