Lapointe Antoine, Royer Moreau Nikyel, Simonyan David, Rousseau François, Mallette Viviane, Préfontaine-Racine Frédérique, Paquette Caroline, Mallet Myriam, St-Pierre Annie, Berthelot Simon
Département de médecine familiale et de médecine d'urgence, Université Laval, Québec, Canada.
Centre de recherche du CHU de Québec - Université Laval, Québec, Canada.
Open Access Emerg Med. 2021 Jan 18;13:13-21. doi: 10.2147/OAEM.S289748. eCollection 2021.
With rising healthcare costs limiting access to care, the judicious use of diagnostic tests has become a critical issue for many jurisdictions. Calcium, magnesium and phosphorus serum levels are regularly performed tests in the emergency department, but their clinical relevance have come into question. Authors sought to determine risk factors that could predict abnormal calcium, magnesium and phosphorus serum levels, as well as identify patients who may need corrective interventions.
A retrospective cohort study was conducted in two academic hospitals in Québec City. Demographic and clinical characteristics of 1008 patients who had serum calcium and/or magnesium and/or phosphorus levels drawn by an emergency physician were collected. Multivariate logistic regression models were fitted to obtain adjusted odds ratios for each risk factor for abnormal calcium or magnesium or phosphorus blood levels, and for a required intervention.
Among patients for whom calcium, magnesium and phosphorus were tested in the Emergency Department, the most significant risk factors (OR>2) for electrolytic abnormality were as follows: hypocalcemia - respiratory distress, diuretics (excluding loop and thiazide), anti-neoplastic medication, long QTc, chronic kidney disease (CKD); hypercalcemia - bone pain, vitamin D, hallucinations; hypomagnesemia - diabetes, corticosteroids; hypermagnesemia - poor extremity perfusion, CKD, furosemide; hypophosphatemia - seizure; hyperphosphatemia - phosphate-binders, CKD, peripheral vascular atherosclerotic disease. Of all patients tested, 3.4% received a corrective intervention initiated by the emergency physician. Predictors of intervention on an electrolyte abnormality include poor peripheral perfusion, nausea and chronic obstructive pulmonary disease (COPD).
Emergency physicians can potentially reduce the unnecessary testing of calcium, magnesium and phosphorus blood levels by targeting patients with high-acuity conditions or chronic comorbidities such as CKD, diabetes and COPD.
随着医疗成本的上升限制了医疗服务的可及性，明智地使用诊断测试已成为许多司法管辖区的关键问题。血清钙、镁和磷水平检测是急诊科经常进行的检查，但它们的临床相关性受到了质疑。作者试图确定可预测血清钙、镁和磷水平异常的风险因素，并识别可能需要纠正干预的患者。
在魁北克市的两家学术医院进行了一项回顾性队列研究。收集了1008例由急诊医生检测血清钙和/或镁和/或磷水平的患者的人口统计学和临床特征。采用多变量逻辑回归模型，以获得钙、镁或磷血水平异常及所需干预的各风险因素的调整比值比。
在急诊科接受钙、镁和磷检测的患者中，电解质异常的最显著风险因素（比值比>2）如下：低钙血症——呼吸窘迫、利尿剂（不包括袢利尿剂和噻嗪类利尿剂）、抗肿瘤药物、长QTc、慢性肾脏病（CKD）；高钙血症——骨痛、维生素D、幻觉；低镁血症——糖尿病、皮质类固醇；高镁血症——肢体灌注不良、CKD、呋塞米；低磷血症——癫痫发作；高磷血症——磷结合剂、CKD、外周血管动脉粥样硬化疾病。在所有接受检测的患者中，3.4%接受了由急诊医生发起的纠正干预。针对电解质异常进行干预的预测因素包括外周灌注不良、恶心和慢性阻塞性肺疾病（COPD）。
急诊医生可以通过针对患有高急症或慢性合并症（如CKD、糖尿病和COPD）的患者，潜在地减少血清钙、镁和磷水平的不必要检测。
