Proposal of Laboratory Test Panel Based on Patients' Chief Complaints in Emergency Department

Hyun Chul Lee; Yu Kyung Kim; Jung Hup Song; Kyung Eun Song

doi:10.3343/kjlm.2010.30.4.444

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Lee, Kim, Song, and Song: Proposal of Laboratory Test Panel Based on Patients' Chief Complaints in Emergency Department

Original Article

Korean J Leg Med 2010;30(4):444-450.

Published online: 14 January 2010

DOI: https://doi.org/10.3343/kjlm.2010.30.4.444

Proposal of Laboratory Test Panel Based on Patients' Chief Complaints in Emergency Department

Hyun Chul Lee, M.D.¹, Yu Kyung Kim, M.D.¹, Jung Hup Song, M.D.², Kyung Eun Song, M.D.¹

¹Department of Clinical Pathology, Kyungpook National University School of Medicine, Daegu, Korea

²Department of Occupational Medicine, Kyungpook National University Hospital, Daegu, Korea

Corresponding author: Kyung Eun Song, M.D. Department of Clinical Pathology, Kyungpook National University School of Medicine, 101 Dongin-dong 2 ga, Jung-gu, Daegu 700-422, Korea Tel: +82-53-420-5278, Fax: +82-53-426-3367 E-mail: kesong@knu.ac.kr

Revised 24 March 201011 May 2010 Accepted 21 July 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background:

A test panel is a group of tests that are simultaneously performed for diagnosis and follow-up of patients. Organ-specific or disease-specific test panels are currently available. Since the patient's chief complaint plays a key role in obtaining the personal and medical history and performing physical examinations, we proposed a test panel based on the chief complaints of the patients.

Methods:

We collected data from 3,127 adults with apparent symptoms who visited the emergency department from April 2009 to May 2009. Subsequently, we classified the patients' chief complaints, ordered the laboratory tests on the basis of these complaints, considered the patients' disease entities, and reviewed the relevant literature.

Results:

The patients were categorized into 14 groups on the basis of the most common chief complaints presented in the emergency department. We first selected the basic test panels and then organized the test panel for each chief complaint to enable differential diagnosis.

Conclusions:

We proposed test panels based on the chief complaints of the patients; these test panels could allow rapid diagnosis and be more useful than the organ-specific or disease-specific tests in critical pathway development. The next step will be evaluating the efficiency and cost effectiveness of the test panel that we suggested.

Keywords: Test panel, Chief complaint, Critical pathway

REFERENCES

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Fig. 1.

The 14 most common chief complaints presented in the emergency department.

Table 1.

Laboratory test ordering done on the basis of chief complaints (%)

Chief complaints	N	Test items
Chief complaints	N	CBC with diff	BUN/Cr	Na/K	LFT∗	UA/Sedi	Glucose	CRP	ESR	PT/aPTT	Ca/P	Uric acid	GGT	D-bil
Abdominal pain	204	96.6	96.1	96.1	95.6	95.6	88.2	87.7	80.4	94.6	77.5	73.0	80.4	85.8
Fever	141	94.3	94.3	92.9	93.6	90.8	75.9	91.5	83.0	58.2	86.5	53.2	44.0	44.0
Chest pain	89	100.0	100.0	100.0	100.0	100.0	92.1	100.0	32.6	100.0	86.5	85.4	75.3	75.3
Respiratory distress	82	100.0	100.0	100.0	100.0	100.0	97.6	91.5	85.4	97.6	93.9	91.5	80.5	79.3
Headache	73	95.9	94.5	95.9	94.5	89.0	90.4	74.0	75.3	90.4	32.9	30.1	30.1	30.1
Weakness	69	97.1	98.6	97.1	98.6	97.1	97.1	92.8	85.5	95.7	58.0	58.0	68.1	66.7
Confusion/syncope/coma	54	98.1	98.1	98.1	98.1	98.1	98.1	79.6	75.9	98.1	68.5	68.5	29.6	31.5
Cough/hemoptysis	44	93.2	93.2	93.2	93.2	90.9	81.8	90.9	90.9	79.5	93.2	79.5	70.5	70.5
Dizziness/vertigo	43	100.0	95.3	95.3	95.3	95.3	95.3	86.0	79.1	97.7	60.5	58.1	46.5	46.5
Hematemesis/hematochezia/melena	30	100.0	100.0	100.0	100.0	100.0	96.7	90.0	56.7	100.0	93.3	83.3	83.3	83.3
Back pain	29	100.0	100.0	100.0	100.0	100.0	100.0	79.3	79.3	100.0	31.0	31.0	24.1	24.1
Nausea/vomiting	28	96.4	96.4	100.0	96.4	96.4	89.3	82.1	75.0	92.9	89.3	85.7	75.0	71.4
Seizure	25	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0	36.0	100.0	32.0	16.0	16.0
Abdominal swelling/ascites	21	100.0	90.5	95.2	95.2	81.0	81.0	85.7	66.7	81.0	71.4	71.4	76.2	76.2

^∗ LFT: assessment of total protein, albumin, total bilirubin, AST, ALT, and alkaline phosphatase.

Abbreviations: N, number of patients; CBC with diff, complete blood cell count with differential count; BUN/Cr, blood urea nitrogen/creatinine; LFT, liver function test; UA/Sedi, urinalysis/sediment; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; PT/aPTT, prothrombin time/activated partial thromboplastin time; GGT, γ-glutamyl transferase; D-bil, direct bilirubin.

Table 2.

Additional tests ordered, other than those in table 1

Chief complaints	Tests ordered, other than those in table 1, at visit		Additional tests
Chief complaints	Test items	(%)	Test items	(%)
Abdominal pain	Amylase/lipase	73.0	Blood culture	30.4
Fever	Blood culture	100.0
Chest pain	CK-MB/Troponin I	87.6
	NT pro-BNP	64.0
	Blood culture	73.2
	ABGA	73.2
Respiratory distress	NT pro-BNP	58.5
	CK-MB/Troponin I	54.9
	LDH	50.0
Headache	CK-MB	64.4
Weakness	CK-MB/Troponin I	71.0	Blood culture	21.7
			Ca/P/Uric acid	21.7
Confusion/syncope/coma	CK-MB/Troponin I	85.2
	ABGA	81.5
	Amylase/lipase	57.4
	NH₃	53.7
Cough/hemoptysis	ABGA	75.0
	Blood culture	70.5
	D-dimer	65.9
	LDH	61.4
	PB smear	61.4
	Respiratory specimen study∗	61.4
	NT pro-BNP	59.1
	Procalcitonin	59.1
Dizziness/vertigo	CK-MB/Troponin I	58.1	Ca/P/Uric acid	20.9
			Lipid study^†	18.6
Hematemesis/hematochezia/melena	NH₃	73.3	Cross Matching	26.7
Back pain	CK-MB/Troponin I	72.4
	ABGA	65.5
Seizure	NH₃	100.0
	ABGA	92.0
	Ionized calcium	80.0
Abdominal swelling/ascites	Amylase/lipase	61.9	Ascitic fluid study^‡	38.1

^∗ Respiratory specimen study: wet smear, Gram stain, acid-fast bacilli (AFB) stain, AFB culture, potassium hydroxide mount, and culture for fungal growth;

^† Lipid study: total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglyceride;

^‡ Ascitic fluid study: albumin, cell count, glucose, LDH, protein, wet smear, Gram stain, culture for fungal growth, AFB stain/culture, and KOH mount.

Abbreviations: CK-MB, creatine kinase-MB; NT pro-BNP, N-terminal pro-B-type natriuretic peptide; ABGA, arterial blood gas analysis; LDH, lactate dehydrogenase; PB smear, peripheral blood smear.

Table 3.

Basic tests included in the panel

CBC with diff

LFT (TP/alb/T-bil/AST/ALT/ALP)

UA/sedi

Coagulation test (PT/aPTT)

Na/K

BUN/Cr

CRP

Glucose (blood/serum)

Ca/P

Abbreviations: CBC with diff, complete blood cell count with differential count; LFT, liver function test; TP, total protein; alb, albumin; T-bil, total bilirubin; ALP, alkaline phosphatase; UA/sedi, urinalysis/sediment; PT/aPTT, prothrombin time/activated partial thromboplastin time; BUN/Cr, blood urea nitrogen/creatinine; CRP, C-reactive protein.

Table 4.

Proposed test panel based on patients' chief complaints

Chief complaints	Essential test panel	Extended test panel
Abdominal pain	Basic tests∗	β-HCG (women of child-bearing age)
	Direct bilirubin
	Amylase/lipase
Fever	Basic tests	HIV antibody
	Blood smear	Body fluid study (stain, culture, and chemistry)
	Blood/urine culture
Chest pain	Basic tests	Lipid study^†
	CK-MB/Troponin I (or Troponin T)
	Myoglobin
	NT pro-BNP (or BNP)
	D-dimer
Respiratory distress	Basic tests	Thyroid function test
	ABGA
	D-dimer
Headache	Basic tests	Lipid study
	CSF study^‡
Weakness	Basic tests	Lipid study
	Uric acid	CK-MB/Troponin I (or Troponin T)
Confusion/syncope/coma	Basic tests	Direct bilirubin
	ABGA	GGT
	CSF study
	NH₃
	Osmolality
Cough/hemoptysis	Basic tests
	Sputum culture/stain/cytology
	D-dimer
Dizziness/vertigo	Basic tests	CK-MB/Troponin I (or Troponin T) Aldosterone
Hematemesis/hematochezia/melena	Basic tests
	Fecal occult blood
	Fecal leukocyte count
Back pain	Basic tests
Nausea/vomiting	Basic tests
	ABGA
	Amylase/lipase
	Direct bilirubin
	NH₃
	Uric acid
Seizure	Basic tests
	Toxicology (alcohol, drug screen) CSF study
Abdominal swelling/ascites	Basic tests
	Ascitic fluid study^§
	Direct bilirubin
	GGT
	Amylase/lipase
	Uric acid

^∗ Basic tests: Refer to Table 3;

^† Lipid study: Refer to Table 2;

^‡ CSF study: culture, Gram stain, and cell count; ^§ Ascitic fluid study: Refer to Table 2. Abbreviations: β-HCG, β-human chorionic gonadotropin; CK-MB, creatine kinase-MB; NT pro-BNP, N-terminal pro-B-type natriuretic peptide; BNP, B-type natriuretic peptide; ABGA, arterial blood gas analysis; GGT, γ-glutamyl transferase.

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