Investigating Investigation (Ab)Use: Thyroid Function Test Audit in a Tertiary Care Teaching Institute in Eastern India
Tóm tắt
An essential component of contemporary health care is laboratory testing. As the utilization of diagnostic tests grow, there is also an increase in the scrutiny of such tests for its effectiveness, balance of cost and over- utilization. Thyroid dysfunction is common across all age groups and is associated with a number of comorbid states. The thyroid function tests (TFTs) are very important for the diagnosis and monitoring of such patients. The guidelines recommend serum thyroid stimulating hormone (TSH) as the single most reliable test to diagnose all common forms of hypothyroidism and hyperthyroidism, except in few cases. This study was conducted to study the investigation requesting pattern of TFTs. Our results showed that TFT panel was ordered in almost equal numbers (35.58%) as single test of TSH (41.27%). Subclinical thyroid disease was diagnosed in 22.1% of cases and the rest were excluded as having any thyroid dysfunction. Over 2/3rd of all requests were for women. An important conclusion from our study was that, the essentiality of lab tests is a decision entirely in the hands of the treating physician keeping in mind the cost and best outcome for patients. Hospitals can develop strategic protocols for ordering laboratory tests keeping resources, need and patient satisfaction and outcomes optimal.
Tài liệu tham khảo
Rubinstein M, Hirsch R, Bandyopadhyay K, Madison B, Taylor T, Ranne A, et al. Effectiveness of practices to support appropriate laboratory test utilization. Am J Clin Pathol. 2018;149(3):197–221.
Gilmour JA, Weisman A, Orlov S, Goldberg RJ, Goldberg A, Baranek H, et al. Promoting resource stewardship: reducing inappropriate free thyroid hormone testing. J Eval Clin Pract. 2017;23(3):670–5.
Baral N, Koner BC, Lamsal M, Niraula I, Dhungel S. Thyroid function testing in eastern nepal and the impact of CME on subsequent requests. Trop Dr. 2001;31(3):155–7.
Gupta S, Verma M, Gupta AK, Kaur A, Kaur V, Singh K. Are we using thyroid function tests appropriately? Indian J Clin Biochem. 2011;26(2):178–81.
Kluesner JK, Beckman DJ, Tate JM, Beauvais AA, Kravchenko MI, Wardian JL, et al. Analysis of current thyroid function test ordering practices. J Eval Clin Pract. 2018;24(2):347–52.
Baskin HJ, Cobin RH, Duick DS, Gharib H, Guttler RB, Kaplan MM, et al. American association of clinical endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocr Pract. 2002;8(6):457–69.
Marot D, Maquart F-X, Delemer B, Decoudier B. Consistent, but totally misleading, thyroid function test results. Clin Chem. 2017;63(3):788–9.
Sethi B, Barua S, Raghavendra MS, Gotur J, Khandelwal D, Vyas U. The thyroid registry: clinical and hormonal characteristics of adult Indian patients with hypothyroidism. Indian J Endocrinol Metab. 2017;21(2):302–7.
Joshi SR. Laboratory evaluation of thyroid function. J Assoc Physicians India. 2011;59(Suppl):14–20.
Kurian M, Kapoor N. Interpretation of thyroid function tests. Curr Med Issues. 2018;16(2):34.
Ladenson PW, Singer PA, Ain KB, Bagchi N, Bigos ST, Levy EG, et al. American thyroid association guidelines for detection of thyroid dysfunction. Arch Intern Med. 2000;160(11):1573–5.
Roti E, Gardini E, Magotti MG, Pilla S, Minelli R, Salvi M, et al. Are thyroid function tests too frequently and inappropriately requested? J Endocrinol Invest. 1999;22(3):184–90.
Roy S, Bhattacharjee A, Mukherjee A, Jaisawal D, Das SN, Pal R. Cases referred for tests of thyroid function disorders at a tertiary care teaching hospital of Bihar: some experience. Indian J Public Health. 2006;50(4):236–8.
Chauduri S, Roy A, Mukhergee A, Biswas AB. An analysis of cases referred for thyroid function disorder in a teaching hospital of Calcutta. Indian J Public Health. 1996;40(2):50–1.
Roukema J, Steyerberg EW, van der Lei J, Moll HA. Randomized trial of a clinical decision support system: impact on the management of children with fever without apparent source. J Am Med Inform Assoc. 2008;15(1):107–13.