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The Low Diagnostic Utility of Rechecking Hemoglobins within 24 Hours in Hospitalized Patients.
Am J Med. 2016 Jul 21;
Authors: Rajkomar A, McCulloch CE, Fang MC
Abstract
PURPOSE: Clinicians often repeat hemoglobin tests within a 24 hour period to detect or monitor anemia. We sought to determine the percentage of hemoglobin tests repeated within a single hospital day that were at least 1.0 g/dL lower than the first test.
METHODS: We performed a retrospective cross-sectional analysis of hospitalized adults on medical or surgical services over a year at a single academic hospital. Using patient and laboratory data in the electronic health record, we analyzed the proportion of repeated hemoglobin tests that was at least 1 g/dL less than the initial hemoglobin value of that day, excluding days when transfusions were administered.
RESULTS: A total of 88,722 hemoglobin tests were obtained from 12,877 unique patients, who contributed a total of 86,859 hospitalization days. In 12,230 (14.1%) of those days, two or more hemoglobin tests were obtained within a single day. In the 6,969 patients who had two hemoglobin tests obtained on the same day and no transfusions given, 949 (13.5%) were ≥ 1 g/dL lower than the initial hemoglobin value of that day and 260 (3.7%) were ≥ 2 g/dL lower. Repeated tests did not often reach transfusion thresholds: 482(6.9%) of repeat hemoglobin values were < 8 g/dL and 64 (0.9%) were < 7 g/dL.
CONCLUSIONS: Hemoglobin tests were repeated in 14% of hospital days. For patients who had two hemoglobin tests obtained on the same day, 13.5% demonstrated a clinically significant drop. This information may be helpful to clinicians when considering whether repeat testing is appropriate.
PMID: 27452681 [PubMed - as supplied by publisher]