Annals of Laboratory Medicine

Korean Society for Laboratory Medicine (대한진단검사의학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Lee, Hyun-Chul (Department of Clinical Pathology, Kyungpook National University School of Medicine) ;
  • Kim, Yu-Kyung (Department of Clinical Pathology, Kyungpook National University School of Medicine) ;
  • Song, Jung-Hup (Department of Occupational Medicine, Kyungpook National University Hospital) ;
  • Song, Kyung-Eun (Department of Clinical Pathology, Kyungpook National University School of Medicine)
  • Received : 2010.03.24
  • Accepted : 2010.07.21
  • Published : 2010.08.31
⟨ Previous Next ⟩

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.

배경 : 패널검사는 질환의 진단 및 치료 전후의 환자 상태를 판정하기 위해서 필요한 진단의학검사 종목으로 구성된 것으로, 현재 장기별 혹은 질환별 패널검사가 이용되고 있다. 환자의 주요호소증상은 병력청취와 신체검사의 방향을 제시하고 진단의학검사를 의뢰하는 중요한 단서가 되므로, 저자들은 처음 병원을 방문한 환자들을 대상으로 주요호소증상에 따라 패널검사를 구성하는 것을 제안하였다. 방법 : 2009년 4월부터 5월까지 본원 응급실을 방문한 환자 중에서 비교적 뚜렷한 한가지 주요호소증상을 호소한 성인 환자 3,127명을 대상으로 주요호소증상을 파악하고 내원 당시와 추가로 의뢰된 진단의학검사 종목과 빈도, 최종진단명을 조사하였고 감별해야 할 질환과 문헌들을 참고하였다. 결과 : 응급실을 방문한 환자들을 대상으로 흔한 순서로 14개의 주요호소증상군을 선정하였다. 이에 따라 기본 패널검사 종목을 우선적으로 선정하였고, 최종 진단된 질병과 감별해야 할 질병에 따라 반드시 필요하다고 생각되는 검사들을 추가하여 주요호소증상별 패널검사를 구성하였다. 결론 : 주요호소증상별 패널검사가 종래에 사용하던 장기별 혹은 질환별 패널검사에 비해 환자의 빠른 진단에 더 도움이 되고 진료계획표(critical pathway)의 한 부분으로서도 필요하리라 생각되었다. 앞으로 저자들이 제안한 패널검사의 실용성과 비용효과적인 면을 평가하고, 이번에 다루지 못한 주요호소증상들에 대해서도 패널검사 종목을 제안하는 것이 다음 과제라고 생각한다.

Keywords

References

  1. Korean Society for Laboratory Medicine. Laboratory test panels for diseases. In: Laboratory medicine. 4th ed. Seoul: E-PUBLIC, 2009: 1047-50. (대한진단검사의학회. 질환군별 기본검사 패널. In: 진단검사의학. 제4판. 서울: 이퍼블릭, 2009: 1047-50.)
  2. Jaros ML, Lifshitz MS, De Cresce RP. Financial management. In: McPherson RA and Pincus MR, eds. Henry's clinical diagnosis and management by laboratory methods. 21st ed. Philadelphia: Saunders Elsevier, 2007:126-7.
  3. Glenn GC. Practice parameter on laboratory panel testing for screening and case finding in asymptomatic adults. Laboratory Testing Strategy Task Force of the College of American Pathologists. Arch Pathol Lab Med 1996;120:929-43.
  4. Takemura Y, Ishida H, Inoue Y, Beck JR. Common diagnostic test panels for clinical evaluation of new primary care outpatients in Japan: a cost-effectiveness evaluation. Clin Chem 1999;45:1752-61.
  5. Boland BJ, Wollan PC, Silverstein MD. Yield of laboratory tests for case-finding in the ambulatory general medical examination. Am J Med 1996;101:142-52. https://doi.org/10.1016/S0002-9343(96)80068-4
  6. Fleischer AB Jr, Gardner EF, Feldman SR. Are patients' chief complaints generally specific to one organ system? Am J Manag Care 2001;7:299-305.
  7. Korea National Statistical Office. Korean standard classification of diseases. Seoul: Korea National Statistical Office, 2008. (통계청. 한국표준질병 사인분류. 서울: 통계청, 2008.)
  8. Fauci AS, Braunwald E, et al. eds. Harrison's principles of internal medicine. 17th ed. New York: McGraw-Hill, 2008:81-384.
  9. Realdi G, Previato L, Vitturi N. Selection of diagnostic tests for clinical decision making and translation to a problem oriented medical record. Clin Chim Acta 2008;393:37-43. https://doi.org/10.1016/j.cca.2008.03.024
  10. Lehmann C and Leiken AM. Influence of selective vs. panel chemistry tests on cost and diagnostic time. Am J Med Technol 1982;48:833-6.
  11. Takemura Y, Ishida H, Inoue Y, Kobayashi H, Beck JR. Opportunistic discovery of occult disease by use of test panels in new, symptomatic primary care outpatients: yield and cost of case finding. Clin Chem 2000;46:1091-8.
  12. Takemura Y, Ishida H, Inoue Y, Beck JR. Yield and cost of individual common diagnostic tests in new primary care outpatients in Japan. Clin Chem 2002;48:42-54.

Cited by

  1. A survey of doctors reveals that few laboratory tests are of primary importance at the Emergency Department vol.1, pp.3, 2010, https://doi.org/10.1515/dx-2014-0025
  2. A survey of doctors reveals that few laboratory tests are of primary importance at the Emergency Department vol.1, pp.3, 2010, https://doi.org/10.1515/dx-2014-0025
  3. Active intervention in hospital test request panels pays vol.53, pp.5, 2010, https://doi.org/10.1515/cclm-2014-0575
  4. Active intervention in hospital test request panels pays vol.53, pp.5, 2010, https://doi.org/10.1515/cclm-2014-0575
  5. Practical motives are prominent in test-ordering in the Emergency Department vol.55, pp.10, 2017, https://doi.org/10.1515/cclm-2016-1092
  6. Practical motives are prominent in test-ordering in the Emergency Department vol.55, pp.10, 2017, https://doi.org/10.1515/cclm-2016-1092