Nonmedical complications of diagnostic workup for dementia [clinic conference]

Patterns of syphilis testing in the elderly

OBJECTIVE

To evaluate the frequency of inconsistencies in the use of laboratory tests for syphilis among the elderly in an acute care setting.

DESIGN

Retrospective medical record review.

SETTING

Academic medical center.

PATIENTS/PARTICIPANTS

All patients 60 years of age and older who had: 1) positive tests for syphilis and no lumbar puncture performed (n = 71), 2) lumbar punctures performed and no positive test for syphilis (n = 68), and 3) positive tests for syphilis and lumbar punctures performed (n = 8).

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The chronology and results of syphilis tests were abstracted from the medical records. Documentation of signs and symptoms of neurosyphilis, including dementia and depression, were abstracted from the medical records by a second reviewer. Most patients had inadequate evaluations; 51 had no follow-up of positive syphilis tests and 43 had cerebrospinal fluid syphilis tests in the absence of positive blood tests for syphilis or signs and symptoms of neurosyphilis.

CONCLUSIONS

The inconsistent pattern of serologic testing in this study suggests that the testing was done as a routine procedure and not for a specific purpose. For a majority of the tested individuals, the results did not provide a public health benefit or contribute to the individual's well-being.