Southwestern Surgical Congress. Annual Meeting. Scottsdale, Arizona (USA), 1996/04/28.
Routine laboratory evaluation of preoperative patients has not been shown to be cost effective when a detailed history and physical examination are performed.
However, since such a detailed history is not possible in trauma patients, the time-honored approach has been for laboratory evaluation to be protocol driven.
The cost-benefit ratio of this practice has never been evaluated.
Trauma patients who underwent routine laboratory evaluation (n=552 ; group I) were compared with patients who had laboratory evaluation based on clinical need (n=603 ; group II).
A concurrent review of each case in group II was conducted every day while a retrospective review of charts was conducted for patients in group I to determine patient care issues and identify abnormal trauma center test results.
The number of patients with laboratory tests decreased from 97% in group I to 27% in group II (P<0.0001).
Positive chemistry profiles increased (55% versus 92% ; P<0.0001) as did coagulation profiles (8% versus 33% ; P<0.0001).
There were no differences in the percentage of patients receiving intervention based on laboratory data (7% in group I versus 8% in group II).
No adverse effect on patient care was identified as a result of absent laboratory information in group II.
Mortality, length of stay, and intensive care unit days were statistically unchanged.
There was an annualized savings of $1.5 million in billed trauma center laboratory charges in group II. (...)
Mots-clés Pascal : Polytraumatisme, Exploration microbiologique, Hémogramme, Ionogramme, Sélection, Examen laboratoire, Intérêt, Analyse avantage coût, Etude statistique, Homme, Traumatisme, Biologie, Economie santé
Mots-clés Pascal anglais : Multiple injury, Microbiological investigation, Blood cell count, Ionogram, Selection, Laboratory investigations, Interest, Cost benefit analysis, Statistical study, Human, Trauma, Biology, Health economy
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Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0035202
Code Inist : 002B24O14. Création : 21/05/1997.