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Lee AYS, Lin MW. Serological intermolecular epitope spreading in a patient with primary Sjögren's syndrome. BMJ Case Rep 2023; 16:16/5/e254632. [PMID: 37130648 PMCID: PMC10163431 DOI: 10.1136/bcr-2023-254632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Sjögren's syndrome (SS) is one of the prototypic systemic autoimmune diseases characterised by autoreactive T and B cells, sicca symptoms and various extraglandular manifestations. SS is characterised by autoantibodies (anti-Ro52/tripartite motif containing-21 [TRIM21], anti-Ro60 and anti-La) that are important diagnostic biomarkers. Patients have typically stable serostatus; that is, patients who are positive for one or more of these autoantibodies tend to remain thus and vice versa. We describe a rare instance where a woman in her 50s was diagnosed with primary SS and developed new autoantibodies subsequently through serological epitope spreading. She demonstrated primarily glandular features only and clinical stability despite serological evolution. In this case report, we discuss the significance of this molecular feature and the clinical implications for our understanding of autoimmunity.
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Affiliation(s)
- Adrian Y S Lee
- Centre for Immunology & Allergy Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, New South Wales, Australia
- Department of Clinical Immunology & Allergy, Westmead Hospital, Westmead, New South Wales, Australia
| | - Ming Wei Lin
- Centre for Immunology & Allergy Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, New South Wales, Australia
- Department of Clinical Immunology & Allergy, Westmead Hospital, Westmead, New South Wales, Australia
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Lee AYS. The Value of a Negative Antinuclear Antibody (ANA) Test: An Often Forgotten Result. REUMATOLOGIA CLINICA 2022; 18:563-564. [PMID: 36309412 DOI: 10.1016/j.reumae.2021.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/05/2021] [Indexed: 06/16/2023]
Affiliation(s)
- Adrian Y S Lee
- ICPMR & Department of Immunology, Westmead Hospital, Westmead, NSW, Australia; Westmead Clinical School, The University of Sydney, Westmead, NSW, Australia.
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Guiñón L, Soler A, López RM, Pajares S, de Aledo JMG, Argudo-Ramírez A, Marín JL, García-Villoria J, Sahuquillo Á, Alvarez L. Inter-rater reliability assessment for the new-born screening quality assurance. Biochem Med (Zagreb) 2022; 32:030901. [PMID: 35966259 PMCID: PMC9344869 DOI: 10.11613/bm.2022.030901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/20/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction To ensure the quality of the new-born screening (NBS), our laboratory reviewed the analytical procedure to detect subjective steps that may represent a risk to the patient. Two subjective activities were identified in the extra-analytical phases: the classification of dried blood spots (DBS) according to their quality and the assignment of haemoglobin patterns. To keep these activities under control, inter-rater studies were implemented. This study aimed to evaluate the inter-rater reliability and the effectiveness of the measures taken to improve the agreement between observers, to assure NBS results’ quality. Materials and methods Dried blood spots specimens were used for the inter-rater studies. Ten studies were performed to assess DBS quality classification, and four to assess the assignment of haemoglobin patterns. Krippendorff’s alpha test was used to estimate inter-rater reliability. Causes were investigated when alpha values were below 0.80. Results For both activities, the reliability obtained in the first studies was inadequate. After investigation, we detected that the criterion to classify a DBS as scant was not consolidated, and also a lack of consensus on whether or not to report Bart’s haemoglobin depending on its percentage. Alpha estimates became higher once the training was reinforced and a consensus about the appropriate criteria to be applied was reached. Conclusion Inter-rater reliability assessment helped us to ensure the quality of subjective activities that could add variability to NBS results. Furthermore, the evolution of the alpha value over time allowed us to verify the effectiveness of the measures adopted.
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Affiliation(s)
- Leonor Guiñón
- Quality Department, Biomedical Diagnostic Center, Hospital Clínic of Barcelona, Barcelona, Spain
- Quality Department, Laboratories, Hospital de la Santa Creu i Sant Pau of Barcelona, Barcelona, Spain
- Biochemistry Department, Hospital de la Santa Creu i Sant Pau of Barcelona, Barcelona, Spain
- Corresponding author:
| | - Anna Soler
- Quality Department, Biomedical Diagnostic Center, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Rosa María López
- Division of Inborn Errors of Metabolism, Biochemistry and Molecular Genetics Department, Biomedical Diagnostic Center, Hospital Clínic of Barcelona, IDIBAPS, BarcelonaSpain
| | - Sonia Pajares
- Division of Inborn Errors of Metabolism, Biochemistry and Molecular Genetics Department, Biomedical Diagnostic Center, Hospital Clínic of Barcelona, IDIBAPS, BarcelonaSpain
- Spain Center for Biomedical Research Network on Rare Diseases (CIBERER), Madrid, Spain
| | - José Manuel González de Aledo
- Division of Inborn Errors of Metabolism, Biochemistry and Molecular Genetics Department, Biomedical Diagnostic Center, Hospital Clínic of Barcelona, IDIBAPS, BarcelonaSpain
| | - Ana Argudo-Ramírez
- Division of Inborn Errors of Metabolism, Biochemistry and Molecular Genetics Department, Biomedical Diagnostic Center, Hospital Clínic of Barcelona, IDIBAPS, BarcelonaSpain
| | - José Luis Marín
- Division of Inborn Errors of Metabolism, Biochemistry and Molecular Genetics Department, Biomedical Diagnostic Center, Hospital Clínic of Barcelona, IDIBAPS, BarcelonaSpain
| | - Judit García-Villoria
- Division of Inborn Errors of Metabolism, Biochemistry and Molecular Genetics Department, Biomedical Diagnostic Center, Hospital Clínic of Barcelona, IDIBAPS, BarcelonaSpain
- Spain Center for Biomedical Research Network on Rare Diseases (CIBERER), Madrid, Spain
| | - Ángeles Sahuquillo
- Section of Analytical Chemistry, Faculty of Chemistry, University of Barcelona, Barcelona, Spain
| | - Luisa Alvarez
- Quality Department, Biomedical Diagnostic Center, Hospital Clínic of Barcelona, Barcelona, Spain
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Lee AYS, Brown DA, McDonald D, Lin MW. Longitudinal Tracking of Extractable Nuclear Antigen (ENA) Antibodies in a Quaternary Hospital Laboratory Cohort Reveals Dynamic Antibody Profiles. J Appl Lab Med 2022; 7:26-35. [PMID: 34996068 DOI: 10.1093/jalm/jfab104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/14/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Antiextractable nuclear antigens (anti-ENAs) are regarded as diagnostic tests with no established value for serial monitoring. We therefore sought to establish the stability over time of anti-ENAs in a large diagnostic immunopathology laboratory. METHODS A retrospective review of all patients who had a serial anti-ENA ordered at the Westmead Hospital (Sydney, Australia) was performed over 24 months. Anti-ENA characterization was performed using line immunoassay, and historical data were available from 2013 onward. The earliest available densitometry readings were compared with the latest available to examine for a change in quantitation or qualitative (serostatus) result (from negative to positive, and vice versa). Medical records were examined for clinical correlations. RESULTS A total of 283 patients (24.1%) had serial testing of anti-ENA in the audit period, with each patient having an average of 3.9 ± 2.9 tests each. Most patients were diagnosed with systemic lupus erythematosus or primary Sjögren's syndrome. About 25% and 58% of patients had a qualitative and quantitative change, respectively, in at least 1 anti-ENA in the study period. Changes in anti-ENA levels correlated with erythrocyte sedimentation rate and disease activity. Increasing duration between serial tests increased the probability of observing a change in anti-ENA levels. CONCLUSION Certain anti-ENAs are dynamic autoantibodies that may have significance for monitoring disease activity. Laboratories may consider reporting quantitative results. Further disease- and autoantibody-specific studies are required to determine the clinical significance of changes in anti-ENAs.
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Affiliation(s)
- Adrian Y S Lee
- Department of Immunopathology, ICPMR and NSW Health Pathology, Westmead Hospital, NSW, Australia.,Department of Immunology, Sydney Medical School, Westmead Hospital, NSW, Australia
| | - David A Brown
- Department of Immunopathology, ICPMR and NSW Health Pathology, Westmead Hospital, NSW, Australia.,Department of Immunology, Sydney Medical School, Westmead Hospital, NSW, Australia.,Centre for Allergy and Immunology Research, The Westmead Institute for Medical Research, NSW, Australia
| | - David McDonald
- Department of Immunopathology, ICPMR and NSW Health Pathology, Westmead Hospital, NSW, Australia
| | - Ming-Wei Lin
- Department of Immunopathology, ICPMR and NSW Health Pathology, Westmead Hospital, NSW, Australia.,Department of Immunology, Sydney Medical School, Westmead Hospital, NSW, Australia.,Centre for Allergy and Immunology Research, The Westmead Institute for Medical Research, NSW, Australia
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Lee A. Fibrillarin antibodies in systemic sclerosis. Arch Rheumatol 2021; 37:311-312. [PMID: 36017207 PMCID: PMC9377177 DOI: 10.46497/archrheumatol.2022.9038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/28/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
- Adrian Lee
- Department of Immunology, ICPMR & Westmead Hospital, Westmead, NSW, Australia
- Westmead Clinical School, The University of Sydney, Westmead, NSW, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
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Xiao Y, Lin Y, Zhang Y, Wang J, Zeng Y. Factors associated with the antinuclear antibody (ANA) titer of systemic autoimmune rheumatic diseases in ANA-positive patients after treatment: a retrospective study. Clin Exp Med 2021; 22:439-446. [PMID: 34542782 DOI: 10.1007/s10238-021-00759-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/28/2021] [Indexed: 01/21/2023]
Abstract
Antinuclear antibodies (ANAs) are a serological hallmark of systemic autoimmune rheumatic diseases (SARDs); however, few studies have investigated their post-treatment levels. The mechanism by which ANA titers are upregulated in SARDs remains unclear. We assessed factors associated with the ANA titer after treatment. In this retrospective study, we analyzed the clinical database of Zhongshan Hospital, Medical College of Xiamen. Demographic data and baseline and 12-month post-treatment ANA titers were collected. Bivariate and multivariate analyses were performed to determine the factors associated with the ANA titer. This study identified 31,923 patients who underwent ANA assay for SARDs screening, and a total of 1043 patients were included in the study. Approximately 16% of the patients showed a decrease in the serological ANA titer. Younger patients (< 20) were 3 × more likely to experience such a decrease (P = 0.005) compared to older patients (≥ 60 years). Having a baseline ANA titer > 1:10,000 was associated with an increase likelihood of a decrease in the serological ANA titer compared with baseline ANA titer 1:10,000, 1:3200 and 1:1000 (P < 0.001). We found that a decrease in the serum ANA titer at 12 months after treatment for SARDs is associated with age and ANA baseline titers.
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Affiliation(s)
- Yun Xiao
- Center of Clinical Laboratory, School of Medicine, Zhongshan Hospital, Xiamen University, Xiamen, 361004, China.,Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, 361004, China
| | - Yiqiang Lin
- Center of Clinical Laboratory, School of Medicine, Zhongshan Hospital, Xiamen University, Xiamen, 361004, China.,Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, 361004, China
| | - Yan Zhang
- Center of Clinical Laboratory, School of Medicine, Zhongshan Hospital, Xiamen University, Xiamen, 361004, China.,Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, 361004, China
| | - Jiajia Wang
- Center of Clinical Laboratory, School of Medicine, Zhongshan Hospital, Xiamen University, Xiamen, 361004, China.,Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, 361004, China
| | - Yanli Zeng
- Center of Clinical Laboratory, School of Medicine, Zhongshan Hospital, Xiamen University, Xiamen, 361004, China. .,Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, 361004, China.
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Lee AYS, Gordon TP. Antinuclear antibody (ANA) monitoring in drug-induced lupus erythematosus (DILE). Rheumatology (Oxford) 2021; 60:2022-2023. [PMID: 33367860 DOI: 10.1093/rheumatology/keaa883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/13/2020] [Accepted: 11/19/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Adrian Y S Lee
- Institute of Clinical Pathology and Medical Research/Westmead Hospital.,Sydney Medical School, The University of Sydney, Westmead, NSW
| | - Tom P Gordon
- SA Pathology and Flinders Medical Centre.,College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
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Lee AYS. The Value of a Negative Antinuclear Antibody (ANA) Test: An Often Forgotten Result. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00117-0. [PMID: 34148826 DOI: 10.1016/j.reuma.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/11/2021] [Accepted: 04/05/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Adrian Y S Lee
- ICPMR & Department of Immunology, Westmead Hospital, Westmead, NSW, Australia; Westmead Clinical School, The University of Sydney, Westmead, NSW, Australia.
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Lee AYS, Beroukas D, Brown L, Lucchesi C, Kaur A, Gyedu L, Hughes N, Ng YH, Saran O, Gordon TP, Wang JJ. Identification of a unique anti-Ro60 subset with restricted serological and molecular profiles. Clin Exp Immunol 2021; 203:13-21. [PMID: 32852779 PMCID: PMC7744494 DOI: 10.1111/cei.13508] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/06/2020] [Accepted: 08/14/2020] [Indexed: 12/30/2022] Open
Abstract
Anti-Ro60 is one of the most common and clinically important serum autoantibodies that has a number of diagnostic and predictive capabilities. Most diagnostic laboratories report this simply as a qualitative positive/negative result. The objective of this study was to examine the clinical and serological relevance of a novel subset of anti-Ro60 in patients who display low levels of anti-Ro60 (anti-Ro60low ). We retrospectively identified anti-Ro60 sera during a 12-month period at a major immunopathology diagnostic laboratory in Australia. These all were anti-Ro60-precipitin-positive on the diagnostic gold standard counter-immuno-electrophoresis (CIEP). Lineblot immunoassay was used to stratify patients into either anti-Ro60low or anti-Ro60high subsets. We compared the medical and laboratory parameters associated with each group. Enzyme-linked immunosorbent assay (ELISA) and mass spectrometry techniques were used to analyse the serological and molecular basis behind the two subsets. Anti-Ro60low patients displayed less serological activity than anti-Ro60high patients with less intermolecular spreading, hypergammaglobulinaemia and less tendency to undergo anti-Ro60 isotype-switching than anti-Ro60high patients. Mass spectrometric typing of the anti-Ro60low subset showed restricted variable heavy chain subfamily usage and amino acid point mutations. This subset also displayed clinical relevance, being present in a number of patients with systemic autoimmune rheumatic diseases (SARD). We identify a novel anti-Ro60low patient subset that is distinct from anti-Ro60high patients serologically and molecularly. It is not clear whether they arise from common or separate origins; however, they probably have different developmental pathways to account for the stark difference in immunological maturity. We hence demonstrate significance to anti-Ro60low and justify accurate detection in the diagnostic laboratory.
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Affiliation(s)
- A. Y. S. Lee
- Department of ImmunologySA Pathology and Flinders Medical CentreBedford ParkSAAustralia
- College of Medicine and Public HealthFlinders UniversityBedford ParkSAAustralia
| | - D. Beroukas
- Department of ImmunologySA Pathology and Flinders Medical CentreBedford ParkSAAustralia
- College of Medicine and Public HealthFlinders UniversityBedford ParkSAAustralia
| | - L. Brown
- Department of ImmunologySA Pathology and Flinders Medical CentreBedford ParkSAAustralia
| | - C. Lucchesi
- Department of ImmunologySA Pathology and Flinders Medical CentreBedford ParkSAAustralia
| | - A. Kaur
- Department of ImmunologySA Pathology and Flinders Medical CentreBedford ParkSAAustralia
| | - L. Gyedu
- Department of ImmunologySA Pathology and Flinders Medical CentreBedford ParkSAAustralia
| | - N. Hughes
- Department of ImmunologySA Pathology and Flinders Medical CentreBedford ParkSAAustralia
| | - Y. H. Ng
- Department of ImmunologySA Pathology and Flinders Medical CentreBedford ParkSAAustralia
| | - O. Saran
- Department of ImmunologySA Pathology and Flinders Medical CentreBedford ParkSAAustralia
| | - T. P. Gordon
- Department of ImmunologySA Pathology and Flinders Medical CentreBedford ParkSAAustralia
- College of Medicine and Public HealthFlinders UniversityBedford ParkSAAustralia
| | - J. J. Wang
- Department of ImmunologySA Pathology and Flinders Medical CentreBedford ParkSAAustralia
- College of Medicine and Public HealthFlinders UniversityBedford ParkSAAustralia
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Yeo AL, Le S, Ong J, Connelly K, Ojaimi S, Nim H, Morand EF, Leech M. Utility of repeated antinuclear antibody tests: a retrospective database study. THE LANCET. RHEUMATOLOGY 2020; 2:e412-e417. [PMID: 38273605 DOI: 10.1016/s2665-9913(20)30084-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/15/2020] [Accepted: 03/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Anti-nuclear antibody (ANA) testing is frequently used as a diagnostic or screening test in patients with inflammatory or musculoskeletal symptoms. The value of repeat testing is unclear. We sought to evaluate the frequency, utility, and cost of repeat ANA testing. The main objective was to assess the positive predictive value of a repeat ANA test for the diagnosis of rheumatological conditions associated with ANA. METHODS In this retrospective cohort study, we analysed data from a single, multisite tertiary health network in Australia across a 7-year period. ANA and other autoimmune test results were obtained from the hospital pathology system with a positive ANA titre cutoff set at 1:160. Clinical information was sourced from clinical information systems on any patient who had a change in ANA result from negative to positive on repeat testing. The cost of repeated ANA testing was calculated using the Australian Government Medicare Benefits Schedule. FINDINGS From March 19, 2011, to July 23, 2018, a total of 36 715 ANA tests were done in 28 840 patients at a total cost of US$675 029 (2018 equivalent). 14 058 (38·3%) of these ANA tests were positive. 7875 (21·4%) of the ordered tests were repeats in 4887 (16·9%) of the patients, among whom 2683 (54·9%) had initially negative tests, and 2204 (45·1%) had initially positive tests. 511 (19·0%) of the 2683 patients with initially negative tests had a positive result on at least one repeat test, with a median time to first positive result of 1·74 years (IQR 0·54-3·60). A change from negative to positive ANA was associated with a new diagnosis in only five (1·1%) of the 451 patients with clinical information available and no previous diagnosis of an ANA-associated rheumatological condition, yielding a positive predictive value of 1·1% (95% CI 0·4-2·7). INTERPRETATION Repeat ANA testing after a negative result has low utility and results in high cost. FUNDING Monash Health.
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Affiliation(s)
- Ai Li Yeo
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia; Department of Rheumatology, Monash Health, Clayton, VIC, Australia
| | - Suong Le
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia
| | - Jason Ong
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia
| | - Kathryn Connelly
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia; Department of Rheumatology, Monash Health, Clayton, VIC, Australia
| | - Samar Ojaimi
- Department of Immunology, Monash Health, Clayton, VIC, Australia
| | - Hieu Nim
- School of Biological Sciences, Monash University, Clayton, VIC, Australia
| | - Eric F Morand
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia; Department of Rheumatology, Monash Health, Clayton, VIC, Australia.
| | - Michelle Leech
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia; Department of Rheumatology, Monash Health, Clayton, VIC, Australia
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Sezgin G, Li L, Wilson R, Westbrook JI, Lindeman R, Vecellio E, Georgiou A. Laboratory Test Utilization and Repeat Testing for Inpatients of Age 80 and Over in Australia: A Retrospective Observational Study. J Appl Lab Med 2019; 4:143-151. [DOI: 10.1373/jalm.2019.029025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/12/2019] [Indexed: 02/02/2023]
Abstract
Abstract
Introduction
Repeat laboratory testing is often necessary in hospitals. However, frequent blood draws can be harmful to older patients. The objective of this study was to identify the most frequently ordered laboratory tests and repeat testing rates for these tests among older inpatients.
Methods
A retrospective observational study of inpatients of age 80 years and over in 4 public hospitals in New South Wales, Australia, was conducted between 2008 and 2013. Proportions of laboratory tests and proportions of repeated tests among the most frequently used tests were reported.
Results
There were 42739 patients with 108003 admissions (56.2% women; 43.2% of ages 80–84). Of these admissions, 95.9% had a laboratory test, with 3012577 tests recorded. Five tests accounted for 62% of all tests and were present in 98.5% of admissions: electrolytes urea and creatinine (EUC; 18% of all tests ordered), complete blood count (CBC; 16.7%), calcium magnesium phosphate (CaMgPhos; 10.2%), liver function test (LFT; 9.0%), and C-reactive protein (CRP; 8.0%). Proportions of repeat tests for this group performed outside recommended minimum repeat intervals were 10.3% EUC, 8.9% CBC, 41.5% CRP, 68.2% CaMgPhos, and 65.2% LFT tests. An exponential increase in repeat testing for all 5 tests was observed around 24 h after a previous test.
Conclusion
Compliance with guidelines on repeat testing intervals among older patients is variable. A better understanding of the underlying reasons for repeat testing would allow targeting of interventions, including decision support, to improve laboratory use for older inpatients.
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Affiliation(s)
- Gorkem Sezgin
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Health and Medical Sciences, Macquarie University, New South Wales, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Health and Medical Sciences, Macquarie University, New South Wales, Australia
| | - Roger Wilson
- New South Wales Health Pathology, Chatswood, New South Wales, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Health and Medical Sciences, Macquarie University, New South Wales, Australia
| | - Robert Lindeman
- New South Wales Health Pathology, Chatswood, New South Wales, Australia
| | - Elia Vecellio
- New South Wales Health Pathology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Health and Medical Sciences, Macquarie University, New South Wales, Australia
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