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

Abstract

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.

Attitudes and beliefs of emergency physicians on lab tests utilization in clinical practice. A multicenter survey

“…1,2 Since rapid and accurate diagnoses followed by appropriate treatments are the mainstays in the field of Emergency Medicine (EM), the Laboratory Medicine (LM) shall modulate its actual organization to fulfill these tasks and hence provide rapid and accurate tests that may allow Emergency Physicians (EPs) to make early rule out or rule in of most urgent and acute disorders. 3 Two Italian scientific societies of EM (Academy of Emergency Medicine and Care, AcEMC) and LM (Italian Society of Clinical Biochemistry and Clinical Molecular Biology, SIBioC) have been precursor for establishing a fruitful collaboration, with publication of many consensus documents on important topics such as panels of urgent diagnostic tests, 4,5 diagnosing acute coronary syndrome, 6 sepsis, 7 and venous thromboembolism. 8 It is commonly perceived that a main obstacle for an effective partnership between EM and LM is the lack of sufficient reciprocal knowledge and understanding.…”

“…More importantly, the authors of this article also concluded that Spanish hospitals would have saved >1 million unnecessary tests by simply harmonizing the diagnostic approaches and establishing a favorable interdepartmental cooperation between EPs and laboratory professionals. 13 Despite some reliable guidance on appropriateness of laboratory test requests in the ED has been published by SIBioC, 14 then mutually agreed by both SIBioC and AcEMC, 4 the real scenario of attitudes and beliefs of EPs on lab tests utilization in clinical practice remains largely unclear. Therefore, this original study was designed to explore this field of medical knowledge, by using a survey on attitudes and beliefs in laboratory diagnostics which was disseminated among many Italian EPs.…”