Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia.
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia.
Ann Emerg Med. 2021 Jul;78(1):150-162. doi: 10.1016/j.annemergmed.2021.01.013. Epub 2021 Mar 26.
Abdominal pain and chest pain are leading reasons for emergency department (ED) presentations, with laboratory tests frequently ordered to aid the diagnostic process. Our study aims to identify EDs with outlying laboratory ordering practices for patients presenting with undifferentiated abdominal pain and chest pain.
This was a retrospective observational study of 519,597 patients who presented with the complaint of abdominal or chest pain at 44 major hospital EDs across New South Wales, Australia, from January 2017 to September 2018. For each condition, we evaluated the risk-adjusted rate of ordering at least 1 laboratory test and of each of the top 15 ordered tests. We used funnel plots to graph variations in test ordering and identify EDs with outlying test-ordering practices. EDs lying above or below the 99.8% funnel control limits were regarded as outliers.
From 3,360,152 unplanned presentations, abdominal pain and chest pain represented 8.8% (n=296,809) and 6.6% (n=222,788) of all cases, respectively. No major outliers were observed for ordering at least one laboratory test; however, variations were observed for individual tests. For abdominal pain, the top 3 tests with the highest ordering variation included glucose (20 outlier EDs), C-reactive protein (10 outliers), and calcium-magnesium-phosphate (7 outliers). For chest pain, the top 3 tests with the highest ordering variation were glucose (21 outlier EDs), C-reactive protein (17 outliers), and liver function test (14 outliers).
Identifying EDs with outlying laboratory-ordering practices is the first step in initiating context-specific evaluation of whether outlying variations are unwarranted.
腹痛和胸痛是急诊科（ED）就诊的主要原因，常进行实验室检查以辅助诊断过程。本研究旨在确定对于表现为不明原因腹痛和胸痛的患者，哪些急诊科存在实验室检查异常的情况。
这是一项回顾性观察性研究，纳入了 2017 年 1 月至 2018 年 9 月期间澳大利亚新南威尔士州 44 家主要医院急诊科就诊的 519597 例以腹痛或胸痛为主要症状的患者。对于每种疾病，我们评估了至少进行 1 项实验室检查的风险调整率，以及前 15 项最常进行的检查。我们使用漏斗图来绘制检查的变异情况，并确定实验室检查异常的急诊科。位于 99.8%漏斗控制限上下的急诊科被视为异常值。
在 3360152 例非计划就诊中，腹痛和胸痛分别占所有病例的 8.8%（n=296809）和 6.6%（n=222788）。至少进行 1 项实验室检查的异常值情况并不明显，但个别检查存在变异。对于腹痛，前 3 项变异最大的检查包括葡萄糖（20 个异常值急诊科）、C 反应蛋白（10 个异常值）和钙镁磷（7 个异常值）。对于胸痛，前 3 项变异最大的检查包括葡萄糖（21 个异常值急诊科）、C 反应蛋白（17 个异常值）和肝功能检查（14 个异常值）。
确定实验室检查异常的急诊科是启动特定于背景的评估的第一步，以确定异常变异是否不合理。
