The prevalence of inappropriate blood tests in pediatric patients scheduled for elective surgery in Thailand: a retrospective chart review
, e | 31 gen 2017
INFORMAZIONI SU QUESTO ARTICOLO
Article Category: Brief communication (Original)
Pubblicato online: 31 gen 2017
Pagine: 809 - 815
DOI: https://doi.org/10.5372/1905-7415.0906.455
Parole chiave
© 2015 Naiyana Aroonpruksakul, Thaniya Stimanont, Pattira Pianchob
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
Figure 1
Demographic and clinical data
| Characteristic | Number (%) |
|---|---|
| Age (years) | |
| 0 to <l | 22 (17) |
| 1 to <8 | 81 (62) |
| 8 to <15 | 27 (21) |
| American Society of Anesthesiologists classification | |
| I | 78 (60) |
| II | 49 (38) |
| III | 3 (2) |
| Grade of surgery | |
| Minor | 113 (87) |
| Major | 17 (13) |
| Service unit | |
| Pediatric surgery | 65 (50) |
| Nonpediatric surgery | 65 (50) |
| Plastic | 12 (9) |
| Orthopedics | 13 (10) |
| Ear, nose, throat | 12(9) |
| Eye | 11 (9) |
| Urogenital | 6 (5) |
| Radiograph | 11 (9) |
| CBC | CXR | EKG | Electrolyte | Bun/Cr | Glucose | Coagulogram | LFTs | ||
|---|---|---|---|---|---|---|---|---|---|
| 1. | Age ≤15 y, healthy, no underlying disease, minor operation, no further lab investigation | ||||||||
| 2. | Preterm PCA <55 wks (PCA = gestational age + age) | ✔ | |||||||
| 3. | Underlying disease e.g. diabetes, heart disease, lung disease, kidney disease, hormone therapy, cancer | ✔ | ✔ | ✔ (Heart disease) | ✔ | ✔ | ✔ (DM) | — | — |
| 4. | Major operation, risk of bleeding | ✔ | ✔ | — | — | ✔ | — | — | — |
| 5. | History of bleeding tendency (e.g. purpura, ecchymosis), on anticoagulant | ✔ | — | — | — | — | — | ✔ | — |
| 6. | Liver disease, jaundice, History of chemotherapy | ✔ | ✔ | — | ✔ | ✔ | ✔ | ✔ | ✔ |
Prevalence of each inappropriate laboratory test request and the possible related factors
| Possible factors | CBC | Electrolyte | Chest X-ray | BUN, Cr | Coagulogram | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| Inapp. n(%) | Inapp. n(%) | Inapp. n(%) | Inapp. n(%) | Inapp. n(%) | ||||||
| I | 36 (46) | 0.02 | 18(23) | 0.83 | 17 (22) | 0.92 | 15(19) | 0.34 | 10(13) | 0.75 |
| II | 12 (25) | 9(18) | 12 (25) | 5(10) | 8(16) | |||||
| III | 0 | 0 | 0 | 0 | 0 | |||||
| 0 to <l | 5(23) | 0.10 | 3(14) | 0.55 | 4(18) | 0.01 | 2(9) | 0.48 | 7(32) | 0.02 |
| 1 to<8 | 29 (36) | 17(21) | 3(16) | 12(15) | 7(9) | |||||
| 8 to<15 | 14 (52) | 7(26) | 12 (44) | 6(22) | 4(15) | |||||
| Minor | 48 (43) | <0.001 | 22 (20) | 0.35 | 20(18) | 0.003 | 19(17) | 0.47 | 10(9) | 0 |
| Major | 0 | 5(29) | 9(53) | 1(6) | 8(47) | |||||
| Pediatric surgery | 10(15) | <0.001 | 9(14) | 0.08 | 9(14) | 0.03 | 7(11) | 0.22 | 13(20) | 0.07 |
| Nonpediatric surgery | 38(59) | 18(28) | 20(31) | 13 (20) | 5(8) | |||||
Total cost estimates of inappropriate laboratory investigations
| Fee (baht) | Total cost (baht) | |
|---|---|---|
| Complete blood count | 90 | 4,320 |
| Urinalysis | 50 | 250 |
| Blood urea nitrogen | 50 | 950 |
| Creatinine | 50 | 950 |
| Electrolyte | 160 | 4,160 |
| Glucose | 40 | 40 |
| Coagulogram | 190 | 3,420 |
| Liver function tests | 350 | 0 |
| Chest radiograph | 220 | 4,400 |
| Electrocardiogram | 200 | 400 |
| Total | 18,890 | |
Prevalence of inappropriate laboratory investigation by ASA, age, grade of surgery, and service unit
| Possible factors | Inappropriate | Total (n) | Prevalence (%) | |
|---|---|---|---|---|
| ASA classification | ||||
| 1 | 41 | 78 | 53 | 0.19 |
| 2 | 28 | 49 | 57 | |
| 3 | 0 | 3 | 0 | |
| Age (years) | ||||
| 0 to <1 | 11 | 22 | 50 | 0.13 |
| 1 to <8 | 39 | 81 | 48 | |
| 8 to <15 | 19 | 27 | 70 | |
| Grade of surgery | ||||
| Minor | 55 | 113 | 49 | 0.01 |
| Major | 14 | 17 | 82 | |
| Service unit | ||||
| Pediatric surgery | 25 | 65 | 39 | 0.001 |
| Nonpediatric surgery | 44 | 65 | 68 |