Duff Delicia, Vyas Niti, Enderle Janet, Rajendran Rajkumar
Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, Texas, USA.
Lab Med. 2023 Sep 5;54(5):489-494. doi: 10.1093/labmed/lmac157.
The aim of this study was to examine appropriate utilization of antinuclear antibody (ANA) screening tests with follow-up subserology tests (reflex testing) for diagnosing systemic autoimmune rheumatic disorder (SARD).
We conducted a retrospective chart review of 3003 SARD-test orders at an academic teaching hospital from January to December 2019. Testing patterns were categorized as American College of Rheumatology (ACR)-recommended reflex testing, panel testing, or single subserology testing. We described testing patterns, assessed their diagnostic accuracy, and explored factors associated with reflex testing.
Reflex testing accounted for 79.7% of SARD test-ordering, whereas improper testing (panel or single subserology) accounted for the other 20.3%. Reflex testing was associated with significantly more SARD diagnoses than improper testing (P = .004). Testing patterns were significantly associated with race/ethnicity (P = .008), with reflex testing being less frequent than improper testing in Hispanics and Whites.
In summary, one-fifth (20.3%) of testing patterns for suspected SARD did not follow the ACR-recommended guidelines for using reflex testing. Use of reflex testing was associated with an increased frequency of SARD diagnosis.
本研究旨在探讨抗核抗体（ANA）筛查试验及后续亚血清学检测（反射试验）在诊断系统性自身免疫性风湿病（SARD）中的合理应用。
我们对一家学术教学医院2019年1月至12月的3003份SARD检测订单进行了回顾性病历审查。检测模式分为美国风湿病学会（ACR）推荐的反射试验、组合检测或单项亚血清学检测。我们描述了检测模式，评估了它们的诊断准确性，并探讨了与反射试验相关的因素。
反射试验占SARD检测订单的79.7%，而不当检测（组合或单项亚血清学检测）占另外的20.3%。与不当检测相比，反射试验诊断出的SARD病例显著更多（P = 0.004）。检测模式与种族/民族显著相关（P = 0.008），西班牙裔和白人中反射试验的频率低于不当检测。
总之，五分之一（20.3%）的疑似SARD检测模式未遵循ACR推荐的反射试验使用指南。反射试验的使用与SARD诊断频率的增加相关。
