Document Detail

Cascade effects of laboratory testing are found to be rare in low disease probability situations: prospective cohort study.
MedLine Citation:
PMID:  19880283     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: (1) To investigate the frequency of cascades of further diagnostic investigations and referrals after abnormal laboratory results in situations of low disease probability; (2) to investigate pretest and posttest determinants; and (3) to describe the cascades that occur. STUDY DESIGN AND SETTING: Prospective cohort study in primary care in The Netherlands. Numbers of investigations/referrals were recorded during 6 months of follow-up for 256 patients with normal and abnormal laboratory results. The influences of the reason for ordering tests, interpretation of results, and pretest/posttest disease probability were examined. RESULTS: After receiving the laboratory results, the physicians ordered further investigations for 22 (17.3%) patients with abnormal results and for two (1.6%) patients with normal results (P<0.001). They referred 12 (9.4%) patients with abnormal results and eight (6.2%) patients with normal results (P=0.33). Six patients had two investigations and/or referrals, and one patient had three referrals. There were significantly more investigations/referrals for results interpreted as abnormal (P=0.004) and for cases with a high posttest disease probability (P=0.001). CONCLUSION: This study suggests that cascade processes after laboratory testing in situations of low disease probability are limited in magnitude and frequency. Improving interpretations may help improve the appropriateness of further investigations and referrals.
Paul H H Houben; Trudy van der Weijden; Ron A G Winkens; Richard P T M Grol
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2009-10-31
Journal Detail:
Title:  Journal of clinical epidemiology     Volume:  63     ISSN:  1878-5921     ISO Abbreviation:  J Clin Epidemiol     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-11     Completed Date:  2010-06-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8801383     Medline TA:  J Clin Epidemiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  452-8     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Elsevier Inc. All rights reserved.
Department of General Practice, School of Public Health and Primary Care (CAPHRI), Maastricht University, NL-6200 MD Maastricht, The Netherlands.
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MeSH Terms
Decision Making
Diagnostic Tests, Routine / utilization*
Middle Aged
Netherlands / epidemiology
Physician's Practice Patterns / statistics & numerical data*
Predictive Value of Tests
Primary Health Care
Prospective Studies
Referral and Consultation / utilization*

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