Weill Cornell Medical College, New York, NY, USA.
Departments of Pathology and Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
J Thromb Haemost. 2016 May;14(5):982-6. doi: 10.1111/jth.13284. Epub 2016 Mar 23.
Essentials Thrombophilia screening has significantly increased but has limited clinical utility. We evaluated the positive rate of thrombophilia screening and adherence to published guidelines. Both the positive rate for thrombophilia screening and the adherence to guidelines were low. Guidance implementation is essential to improve current thrombophilia screening practice.
Background Thrombophilia screening is widely performed but provides limited clinical utility in managing patients predisposed to venous thromboembolism. Although guidelines to limit testing have been published, adherence to those guidelines in the outpatient clinical setting has not been assessed. Objective To evaluate outpatient thrombophilia screening practices at a tertiary academic medical center. Methods We performed a retrospective review of the electronic medical records and a computational analysis of thrombophilia tests collected during a 3-year period (August 2010 to June 2013) at a large teaching hospital. Our primary outcome measures were positive diagnostic yield for thrombophilia and clinician adherence to published thrombophilia screening guidelines in the outpatient setting. Results and Conclusions We found a positive diagnostic yield of 13.8% (95% confidence interval 12.3% to 15.3%) for outpatient thrombophilia screening at our institution. Of the screening tests requiring a second confirmatory assay for definitive diagnosis, only 12% (95% confidence interval 10.3% to 13.7%) were appropriately obtained. We also observed that 73% of patients in our electronic medical record review were inappropriately tested based on existing screening guideline criteria. When parsed by specialty, we identified that hematologists had a higher adherence rate to guideline criteria than do physicians from other specialties. Our study confirms low adherence to thrombophilia screening guidelines across disciplines and indicates the need for continued clinician education.
本研究旨在评估一家三级学术医疗中心的门诊患者进行血栓形成倾向筛查的实践情况。
我们对一家大型教学医院在 3 年期间（2010 年 8 月至 2013 年 6 月）的电子病历进行了回顾性分析，并对血栓形成倾向检测进行了计算分析。我们的主要研究终点是门诊患者血栓形成倾向筛查的阳性诊断率和临床医生在门诊环境中遵循已发表的血栓形成倾向筛查指南的情况。
我们发现，本机构的门诊血栓形成倾向筛查的阳性诊断率为 13.8%（95%置信区间为 12.3%至 15.3%）。在需要进行第二次确认性检测以明确诊断的筛查检测中，只有 12%（95%置信区间为 10.3%至 13.7%）得到了适当的检测。我们还发现，在我们的电子病历回顾中，73%的患者根据现有的筛查指南标准进行了不适当的检测。按照专业进行分类时，我们发现血液科医生比其他专业的医生更遵循指南标准。我们的研究证实，各学科领域对血栓形成倾向筛查指南的遵循率均较低，表明需要继续对临床医生进行教育。
