Document Detail

Prospective evaluation of a clinical guideline for the diagnosis and management of iron deficiency anemia.
MedLine Citation:
PMID:  12361813     Owner:  NLM     Status:  MEDLINE    
PURPOSE: We examined the effect of introducing an evidence-based clinical guideline on the diagnosis and evaluation of iron deficiency anemia. SUBJECTS AND METHODS: The guideline recommended measurement of serum ferritin levels for all anemic patients with a mean corpuscular volume (MCV) </=95 fL and endoscopic evaluation for those with a serum ferritin level less than 45 ng/mL. Physicians practicing in the general medicine inpatient and outpatient services of two university-affiliated hospitals were informed about the guideline and the data supporting it. Clinical evaluations during the 9 months before ("control period," n = 3341 patients) and the 9 months after ("intervention period," n = 3173 patients) the introduction of the guideline were compared. RESULTS: There was a 30% increase (95% confidence interval [CI]: 22% to 39%) in the proportion of anemic patients who underwent serum ferritin evaluation in the intervention period (41% [n = 1284]) compared with in the control period (31% [n = 1040]), and a 24% increase (95% CI: 4% to 48%) in the proportion with a serum ferritin level <45 ng/mL (8.1% [n = 256] vs. 6.5% [n = 217]). The proportion of anemic patients who underwent endoscopic evaluation within 4 months of measurement of low serum ferritin level in the intervention period (3.3% [n = 106]) was 67% higher (95% CI: 23% to 125%) than in the control period (2.0% [n = 67]), and the proportion with serious gastrointestinal lesions found as a result of endoscopy was 62% (95% CI: 8% to 145%) higher (1.8% [n = 57] vs. 1.1% [n = 37]). CONCLUSIONS: Introduction of a guideline describing appropriate evaluation of iron deficiency anemia led to an increase in the proportions of patients evaluated for iron deficiency anemia and found to have serious gastrointestinal lesions.
George N Ioannou; Jeremy Spector; Kevin Scott; Don C Rockey
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  The American journal of medicine     Volume:  113     ISSN:  0002-9343     ISO Abbreviation:  Am. J. Med.     Publication Date:  2002 Sep 
Date Detail:
Created Date:  2002-10-03     Completed Date:  2002-10-22     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  281-7     Citation Subset:  AIM; IM    
Division of Gastroenterology, University of Washington and Health Services Research and Development, Puget Sound Veterans Affairs Health Care System, Seattle, Washington, USA.
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MeSH Terms
Age Distribution
Anemia, Iron-Deficiency / complications,  diagnosis*,  epidemiology
Endoscopy, Gastrointestinal / utilization
Evidence-Based Medicine
Ferritins / blood*
Gastrointestinal Neoplasms / complications,  diagnosis*,  epidemiology
Guideline Adherence
Hospitals, Teaching
Middle Aged
North Carolina / epidemiology
Odds Ratio
Outcome Assessment (Health Care)*
Practice Guidelines as Topic / standards*
Prospective Studies
Risk Factors
Reg. No./Substance:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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