Efficacy of preadmission testing in ambulatory surgical patients

Golub, Robert M.; Cantu, Roberto; Sorrento, Joseph J.; Stein, H D

doi:10.1016/0002-9610(92)90557-8

Cited by 43 publications

(26 citation statements)

References 23 publications

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“…To the best of our knowledge, ours is the only study to examine separate and unique clinical practice guidelines for ordering PT or PTT tests. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] The use of two distinct guidelines in practice may help reinforce differences between indications for these tests and minimize the routine pairing of orders observed by McKinley and Wrenn 29 and confirmed in this study.…”

Section: Discussionmentioning

confidence: 65%

“…Most studies validated PT and PTT guidelines for use in preoperative, general medical, and surgical patient cohorts that are unrepresentative of the broad mix of patients treated in the hospital ED. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Studies specific to ED patients used retrospective cohort designs that may have missed clinical indications that were present but undocumented. 28,29 Indeed, McKinley and Wrenn 29 found that even among patients hospitalized from the ED for initiation of coagulation therapy, emergency physicians rarely documented important coagulopathy screening questions.…”

Section: Discussionmentioning

confidence: 99%

“…2,4 Evidence suggests that readily available historical and physical examination variables can accurately identify preoperative surgical and other admitted patients at low risk for inpatient bleeding complications.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4] Additionally, preoperative PT and PTT test results are poor predictors of abnormal bleeding during and after surgery, 2,[5][6][7][8][9][10][11][12][13][14][15][16][17][18] and abnormal blood coagulation tests are often not acted upon. 2,4 Evidence suggests that readily available historical and physical examination variables can accurately identify preoperative surgical and other admitted patients at low risk for inpatient bleeding complications. 1,3,12 Implementation of these criteria could safely reduce the proportion of PT and PTT test orders for these patients by 50% to 85%.…”

mentioning

confidence: 99%

“…1,3,12 Implementation of these criteria could safely reduce the proportion of PT and PTT test orders for these patients by 50% to 85%. 1,2 How-ever, the validity of these or similar high-yield criteria 19,20,21 has not been examined in an acute care setting where disposition and treatment decisions must be made within a narrow time interval.…”

mentioning

confidence: 99%

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Evaluation of Guidelines for Ordering Prothrombin and Partial Thromboplastin Times

Auble

Taylor

Hsu

et al. 2002

Academic Emergency Medicine

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Objectives: Existing clinical practice guidelines for ordering prothrombin time (PT) and partial thromboplastin time (PTT) tests in the emergency department (ED) include physician expectation of an invasive procedure as a criterion. This study sought to determine whether this criterion accurately identifies patients who undergo an invasive procedure and whether an amalgam of these guidelines identifies patients at low risk of an adverse medical outcome. Methods: A prospective observational cohort study of adults treated in a university medical center ED between July 1997 and March 1998. Physicians were surveyed at order placement to determine the presence of guideline criteria. Adverse clinical outcomes defined as an International Normalized Ratio [INR] > 1.3 or PTT > 39.9 seconds combined with consequent directed medical therapy were abstracted from ED and the first 24 hours of inpatient medical records. Results: The sensitivity of ED physician expectation of an invasive procedure was 60.0%; therefore, it was excluded from both the PT and PTT guidelines. There were 553 patients with a PT test order; test order indications were absent in 190 (34.4%), of which one (0.5%, 95% CI = 0.1% to 2.9%) had adverse outcomes. There were 547 patients with a PTT test; test order indications were absent in 226 (41.3%), of which three (1.3%, 95% CI = 0.4 to 3.8%) had adverse outcomes. All three were taking warfarin when they presented to the ED. Conclusions: Emergency department physician expectation of an invasive procedure for patients with PT or PTT test orders is an insensitive predictor of patients who undergo such procedures. Clinical practice guidelines that exclude this criterion identify ED patients at the time of ED presentation at low risk for adverse medical outcomes in the ED or shortly after admission. Key words: prothrombin time; partial thromboplastin time; guidelines; bleeding; emergency department. ACADEMIC EMERGENCY MEDI-CINE 2002; 9:567-574.Prothrombin time (PT) and partial thromboplastin time (PTT) tests are widely used global screening tests for blood coagulation. Both tests are routinely ordered for surgical and other patients admitted to the hospital even though studies consistently demonstrate the low diagnostic utility of this practice.1-4 Additionally, preoperative PT and PTT test results are poor predictors of abnormal bleeding during and after surgery, 2,5-18 and abnormal blood coagulation tests are often not acted upon. 2,4 Evidence suggests that readily available historical and physical examination variables can accurately identify preoperative surgical and other admitted patients at low risk for inpatient bleeding complications.1,3,12 Implementation of these criteria could safely reduce the proportion of PT and PTT test orders for these patients by 50% to 85%. ever, the validity of these or similar high-yield criteria 19,20,21 has not been examined in an acute care setting where disposition and treatment decisions must be made within a narrow time interval.Clinical practice guidelines exi...

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