North Carolina Children's Hospital and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;
Children's Hospital Association, Overland Park, Kansas.
Hosp Pediatr. 2021 Jun;11(6):563-570. doi: 10.1542/hpeds.2020-005561. Epub 2021 May 5.
Previous pediatric studies have revealed substantial variation in laboratory testing for specific conditions, but clinical outcomes associated with high- versus low-frequency testing are unclear. We hypothesized that hospitals with high- versus low-testing frequency would have worse clinical outcomes.
We conducted a multicenter retrospective cohort study of patients 0 to 18 years old with low-acuity hospitalizations in the years 2018-2019 for 1 of 10 common All Patient Refined Diagnosis Related Groups. We identified hospitals with high-, moderate-, and low-frequency testing for 3 common groups of laboratory tests: complete blood cell count, basic chemistry studies, and inflammatory markers. Outcomes included length of stay, 7- and 30-day emergency department revisit and readmission rates, and hospital costs, comparing hospitals with high- versus low-frequency testing.
We identified 132 391 study encounters across 44 hospitals. Laboratory testing frequency varied by hospital and condition. We identified hospitals with high- (13), moderate- (20), and low-frequency (11) laboratory testing. When we compared hospitals with high- versus low-frequency testing, there were no differences in adjusted hospital costs (rate ratio 0.89; 95% confidence interval 0.71-1.12), length of stay (rate ratio 0.98; 95% confidence interval 0.91-1.06), 7-day (odds ratio 0.99; 95% confidence interval 0.81-1.21) or 30-day (odds ratio 1.01; 95% confidence interval 0.82-1.25) emergency department revisit rates, or 7-day (odds ratio 0.84; 95% confidence interval 0.65-1.25) or 30-day (odds ratio 0.91; 95% confidence interval 0.76-1.09) readmission rates.
In a multicenter study of children hospitalized for common low-acuity conditions, laboratory testing frequency varied widely across hospitals, without substantial differences in outcomes. Our results suggest opportunities to reduce laboratory overuse across conditions and children's hospitals.
之前的儿科研究表明，针对特定病症的实验室检测存在大量差异，但高频与低频检测与临床结果的关联尚不清楚。我们假设，高频与低频检测的医院会有更差的临床结果。
我们进行了一项多中心回顾性队列研究，纳入了 2018 年至 2019 年期间因 10 种常见全患者精炼诊断相关组之一的低危住院患者，年龄 0 至 18 岁。我们确定了高频、中频和低频检测 3 种常见实验室检测组的医院：全血细胞计数、基本化学研究和炎症标志物。比较高频与低频检测的医院，结局包括住院时间、7 天和 30 天急诊复诊和再入院率以及医院费用。
我们在 44 家医院共确定了 132391 次研究就诊。实验室检测频率因医院和病症而异。我们确定了高频（13 家）、中频（20 家）和低频（11 家）检测的医院。当我们比较高频与低频检测的医院时，调整后的医院费用（率比 0.89；95%置信区间 0.71-1.12）、住院时间（率比 0.98；95%置信区间 0.91-1.06）、7 天（比值比 0.99；95%置信区间 0.81-1.21）或 30 天（比值比 1.01；95%置信区间 0.82-1.25）急诊复诊率，或 7 天（比值比 0.84；95%置信区间 0.65-1.25）或 30 天（比值比 0.91；95%置信区间 0.76-1.09）再入院率均无差异。
在一项针对常见低危病症住院儿童的多中心研究中，医院间的实验室检测频率差异很大，但各病症和各医院间的结果并无显著差异。我们的研究结果提示，存在减少各病症和儿童医疗机构中实验室过度检测的机会。
