Exploring the iceberg of inappropriateness in hemostasis testing

Lippi, Giuseppe; Favaloro, Emmanuel J.

doi:10.1515/dx-2017-0002

Cited by 4 publications

(4 citation statements)

References 12 publications

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“…The term appropriateness in laboratory medicine conventionally implies the optimization of human and economic resources, contextually offering the most useful data for improving outcomes and maintaining a high level of safety [11]. Implicit within this concept is that "inappropriateness" may comprise the underutilization of diagnostic tests, which may potentially lead to underdiagnosis or delayed diagnosis when essential laboratory analyses are overlooked [12].…”

Section: Discussionmentioning

confidence: 99%

Laboratory testing in the emergency department: an Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) and Academy of Emergency Medicine and Care (AcEMC) consensus report

Lippi

Panteghini

Bernardini

et al. 2017

Clinical Chemistry and Laboratory Medicine (CCLM)

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Background: The mainstay of patient-oriented laboratory testing in emergency settings entails selecting a number and the type of tests according to valid criteria of appropriateness. Since the pattern of urgent tests requesting is variable across different institutions, we designed a joined survey between the Academy of Emergency Medicine and Care (AcEMC) and the Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) for reaching tentative consensus about the most informative diagnostic tests in emergency settings. Methods: A survey, containing the most commonly ordered urgent laboratory tests and the relative clinical

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Section: Discussionmentioning

confidence: 99%

Laboratory testing in the emergency department: an Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) and Academy of Emergency Medicine and Care (AcEMC) consensus report

Lippi

Panteghini

Bernardini

et al. 2017

Clinical Chemistry and Laboratory Medicine (CCLM)

Self Cite

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show abstract

“…10 The term appropriateness in laboratory medicine conventionally implies the optimization of human and economic resources, contextually offering the most useful data for improving outcomes and maintaining a high level of safety. 11 Implicitly comprised within this concept is the fact that inappropriateness may also be referred to underutilization of diagnostic tests, which may potentially lead to underdiagnosis or delayed diagnosis when essential laboratory analyses are overlooked. 12 A promising approach for enhancing appropriateness of urgent testing encompasses obtaining widespread consensus between emergency physicians and laboratory professionals about a list of informative tests according to specific emergency conditions.…”

Section: Discussionmentioning

confidence: 99%

Laboratory testing in the emergency department: An Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) and Academy of Emergency Medicine and Care (AcEMC) consensus report

et al. 2017

Self Cite

View full text Add to dashboard Cite

The mainstay of patient-oriented laboratory testing in emergency settings entails selecting number and type of tests according to valid criteria of appropriateness.Since the pattern of urgent tests requesting is variable across different institutions, we designed a joined survey between the Academy of Emergency Medicine and Care (AcEMC) and the Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) for reaching tentative consensus about the most informative diagnostic tests in emergency settings. A survey, containing the most commonly performed urgent laboratory tests and the relative clinical indications, was disseminated to eight relevant members of AcEMC and eight relevant members of SIBioC. All contributors were asked to provide numerical scores for the different laboratory parameters, where 1 indicated strongly recommended, 2 recommended in specific circumstances, and 3 strongly discouraged. The mean results of the survey were presented as the mean of responders' values, and the parameters were finally classified as strongly recommended (mean value, 1.0-1.5), somehow recommended (mean value, 1.5-2.0), discouraged (mean value, 2.0-2.5) and strongly discouraged (mean value, 2.5-3.0). The results of the survey allowed defining a hierarchy of priority, wherein 24 tests were strongly recommended. The use of 5 common tests was instead strongly discouraged. For 16 additional parameters in the list, the consensus ranged between somehow recommended and discouraged. We hope that results presented in this joint AcEMC-SIBioC consensus document may help harmonizing panel of tests and requesting patters in emergency setting, at least at a national level.

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“…To prevent these errors, laboratories should employ the best tests and the most comprehensive panel available to them. Although inappropriateness in laboratory testing is commonly considered synonymous of over‐requesting, under‐requesting is also an issue, especially when useful diagnostic tests are overlooked . In essence, a balance is needed between too many and too few tests.…”

Section: Choice Of Test Methodologies and Test Panels As Preanalyticmentioning

confidence: 99%

Preanalytical issues that may cause misdiagnosis in haemophilia and von Willebrand disease

Favaloro

Lippi

2017

Haemophilia

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von Willebrand disease (VWD) and haemophilia represent common inherited or acquired bleeding disorders, but many laboratories and clinicians continue to struggle with their diagnosis or exclusion. Difficulties in achieving a correct diagnosis or exclusion of VWD or haemophilia might be due to analytical issues. Sometimes assays may generate a wrong result (ie an analytical error) or may have limitations in their dynamic range of measurement and/or their level of low analytical sensitivity. Less well recognized is the influence of preanalytical issues on the diagnosis of VWD or haemophilia. Therefore, this narrative review aims to provide an overview of some important preanalytical aspects that may affect the diagnosis of VWD or haemophilia, as well as a range of solutions that may help in mitigating or abrogating their influence. The review includes discussion of the more commonly noted preanalytical issues, such as haemolysis/icterus/lipaemia, and sample collection, processing and transport. However, we also extensively discuss other less well-recognized preanalytical issues, including clinical requests, anticoagulants and anticoagulant therapy, and laboratory test choices to name a few.

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Exploring the iceberg of inappropriateness in hemostasis testing

Cited by 4 publications

References 12 publications

Laboratory testing in the emergency department: an Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) and Academy of Emergency Medicine and Care (AcEMC) consensus report

Laboratory testing in the emergency department: an Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) and Academy of Emergency Medicine and Care (AcEMC) consensus report

Laboratory testing in the emergency department: An Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) and Academy of Emergency Medicine and Care (AcEMC) consensus report

Preanalytical issues that may cause misdiagnosis in haemophilia and von Willebrand disease

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