A-145 Evaluating clinician compliance with laboratory guidance for prolonged aPTT testing
Notice bibliographique
Résumé
Abstract Background Activated partial thromboplastin time (aPTT) is a test used to evaluate coagulation disorders and is frequently ordered in the preoperative setting. When a patient presents with a prolonged aPTT (=> 40 sec) without documented anticoagulant use, our laboratory performs a mixing study with normal plasma to calculate Rosner*s index. The index is computed by our laboratory informatic system, and a comment is posted on the report to guide clinicians toward further investigation either coagulation factor deficiency or lupus anticoagulant/inhibitor. These supplementary tests are costly in terms of technical time and laboratory resources. Herein, we aimed to assess whether the laboratory recommendations were followed by clinicians and to determine whether the laboratory/clinician strategy could be optimized for prolonged aPTT result. Methods We conducted a retrospective study involving 180 patients who had an aPTT result => 40 seconds when analyzed with the Hemosil Synthasil APTT reagent on the ACL TOP analyzer. First, we analyzed the frequency of follow-up investigations and determined whether clinicians adhered to the recommendations provided on laboratory reports. Next, we assessed whether the patients had coagulation factor deficiencies or lupus anticoagulant, and whether these results were consistent with Rosner*s index calculations (= 10 indicating a coagulation factor deficiency and > 10 indicating a lupus anticoagulant). Results All patients with a Rosner index >10 (n=15), who were investigated a for lupus anticoagulant, tested positive, confirming that the laboratory decision limits for Rosner index are acceptable. Among the 180 patients included in our study, 15 died within a week of the initial request, and only 37 (21%) underwent further investigation. Consequently, clinicians did not follow up on 128 patients (78%) with prolonged aPTT. Of the 37 patients who had a follow-up, only 17 were investigated in accordance with the laboratory’s recommendations. A targeted investigation, either for a coagulation factor deficiency or for lupus anticoagulant, was ordered for 22 of those patients. However, 15 patients underwent both investigations, despite the laboratory recommending only one, suggesting suboptimal use of resources. Conclusion Our results raise concerns about the effectiveness of the current investigation strategy for prolonged aPTT. The low adherence of clinician to laboratory recommendations (21%) and the significant proportion of patients who did not receive the appropriate tests (54% of investigated patients) suggest inefficient use of resources. These findings emphasize the need to optimize the laboratory testing algorithm for prolonged aPTT and encourage improved collaboration between the laboratory and clinicians to ensure more effective patient management.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,062 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».