Promptly reporting of critical laboratory values in pediatrics: A work in progress

The effect of laboratory critical value reporting on patient management at Siriraj Hospital - Thailand's largest national tertiary referral center

Critical laboratory values are life-threatening results that necessitate immediate medical intervention. Reporting these values according to established guidelines is essential for ensuring optimal patient safety and care quality. The aim of this study was to evaluate the laboratory critical value reporting system and the actions taken at Siriraj Hospital - Thailand's oldest and largest teaching hospital - during January 2018. This study reviewed critical values from hematology, coagulation, and clinical chemistry tests over a one-month period. Patient management actions in response to critical values were classified into five categories: treatment, further investigation, monitoring, treatment combined with investigation, and other. Descriptive statistics were used to analyze the data in Microsoft Excel 2019, calculating the incidence of critical values, notification rates, and management actions. Of the 253,537 tests that were performed, 2,722 critical levels were found, indicating an incidence rate of 1.1%. Hemoglobin and potassium were the most frequently observed critical parameters, accounting for 25.61% and 23.99% of cases, respectively. The rate of notification varied depending on the specific parameter and patient category. For critical glucose and potassium levels, the most common response was close monitoring within 30 minutes, followed by treatment in 80% of cases. Hypermagnesemia, a condition linked to preeclampsia and treated with magnesium sulfate, required particularly careful monitoring. The 1.1% incidence of critical values in this study is high compared to previously published international data; however, this may be explained by the high volume of complex cases referred to our national tertiary referral center. Critical value reporting criteria should be established based on patient conditions and hospital management practices to reduce unnecessary alerts, optimize laboratory workload, and ensure high-quality patient care.

Identification and characterization of critical values in therapeutic drug monitoring: a retrospective analysis

Therapeutic drug monitoring (TDM) is a crucial clinical practice that improves pharmacological effectiveness and prevent severe drug-related adverse events. Timely reporting and intervention of critical values during TDM are essential for patient safety. In this study, we retrospectively analyzed the laboratory data to provide an overview of the incidence, distribution pattern and biochemical correlates of critical values during TDM. A total of 19,110 samples were tested for nine drug concentrations between January 1, 2019, and December 31, 2020. Of these, 241 critical values were identified in 165 patients. The most common critical values were vancomycin trough (63.4%), followed by tacrolimus trough (16.9%) and digoxin (15.2%). The primary sources of drug critical values were the department of general intensive care unit (ICU), cardiology, and surgery ICU. At baseline or the time of critical value, significant differences were found between the vancomycin, digoxin, and tacrolimus groups in terms of blood urea nitrogen (BUN), creatinine, N-terminal Pro-B-Type Natriuretic Peptide (NT-proBNP), and lymphocyte percentage, P < 0.05. Therefore, it is important to prioritize and closely monitor drug concentrations to reduce laboratory critical values during TDM.

Liver Biopsy Handling of Metabolic-Associated Fatty Liver Disease (MAFLD): the Children's Hospital of Eastern Ontario grossing protocol

Metabolic-(non-alcoholic) associated fatty liver disease (MAFLD/NAFLD) has increasingly become a worldwide epidemic. It has been suggested that renaming NAFLD to MAFLD is critical in identifying patients with advanced fibrosis and poor cardiovascular outcomes. There are concerns that the progression to non-alcoholic steatohepatitis (NASH) may become a constant drive in the future healthcare of children and adolescents. There is a necessity to tackle the emerging risk factors for NASH-associated hepatocellular carcinoma (HCC). In this narrative review, we present the current protocol of liver biopsy separated between pre-analytical, analytical, and post-analytical handling. Genetic association investigations have identified single nucleotide polymorphisms implicated in the progression of MAFLD-HCC, many of which seem to belong to the lipid metabolism pathways. PNPLA3 rs738409 variant, TM6SF2 rs58542926 variant, MBOAT7 rs641738 variant, and GCKR variants seem to be significantly associated with NAFLD disease susceptibility. In disclosing the current comprehensive protocol performed at the Children's Hospital of Eastern Ontario, Ottawa, ON, Canada, we support the most recent Kulkarni-Sarin's pledge to rename NAFLD to MAFLD. Grossing of the liver biopsy is key to identifying histologic, immunophenotypical, and ultrastructure data and properly preserving tissue for molecular genomics data.

Point of care with serial N-terminal pro-B-type natriuretic peptide (NT-proBNP) for heart failure in patients with acute decompensation. An invited commentary

Point-of-care (POC) Testing (POCT) is a medical diagnostic approach carried out outside the clinical laboratory and close to the patient. The results are used for the immediate clinical decision to improve patient care. Accreditation Canada and Diagnostic Accreditation Programs regulatory standards and the College of the American Pathologists for POCT have implemented several guidelines and certifications. POC in heart failure (POC-HF) will demonstrate that it is helpful to develop a preliminary understanding of the value of serial N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements in the diagnostic and therapeutic process in patients hospitalized with acute decompensation of heart failure. In addition, POC-HF will hopefully answer questions on the workability of this approach in clinical routine and the usefulness and justification to perform larger-scale studies investigating this strategy.

Pediatrics: An Evolving Concept for the 21st Century

Pediatrics is rapidly evolving, and the diagnostic tools are expanding the spectrum of diagnoses that can be identified at the bedside [...].

Pediatrics: An Evolving Concept for the 21st Century

Pediatrics is rapidly evolving, and the diagnostic tools are expanding the spectrum of diagnoses that can be identified at the bedside [...].