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David Plaut: Off the Cuff

Test Utilization

Published April 29, 2014 11:21 AM by David Plaut
I recently saw big headlines in a Medical Newspaper that a study showed “How Simple Changes in Reporting Medical Laboratory Test Results to Clinicians Improve Patient Safety and Reduce Inappropriate Use of Antibiotics.” As someone who is interested in test utilization and improving patient safety (reducing risks), I hastened to read further. The study seemed to boil down to reducing urine culture. I dug a bit deeper and found some other articles that agreed with this “new” approach. 
In 1996, Hoberman et al. asked “Is urine culture necessary to rule out UTI in young febrile children?” They found that the presence of both pyruia (> or = 10 white cells / cc) and bacteriuria have a sensitivity of 95% with a positive predictive value of 85%. The team decided on using pyuria alone as the sole criterion for omitting urine cultures. They found that 61% of the specimens did not need culturing. (1)
Ten years later, a review of studies concluded that “Dipstick tests are easy to perform in the GP's surgery, give an immediate result and are relatively cheap. The results of the systematic review showed that a dipstick for leucocyte esterase (LE) and nitrite, where both test results are interpreted in combination, was a good test both for ruling in (both positive) and ruling out (both negative) a UTI.” Before culturing, microscopy was recommended. (2) 
Remember the syllables in research – re-search.
(1) Pediatr Infect Dis J. 1996 Apr;15(4):304-9.
(2) Health Technol Assess. 2006 Oct;10(36):iii-iv, xi-xiii, 1-154.

posted by David Plaut


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