Customized Reference Ranges for Laboratory Values Decrease False Positive Alerts in Intensive Care Unit Patients

Kılıçkaya, Oğuz; Schmickl, Christopher N.; Ahmed, Adil; Pulido, Juan N.; Onigkeit, James A.; Kashani, Kianoush; Gajić, Ognjen; Herasevich, Vitaly; Pickering, Brian

doi:10.1371/journal.pone.0107930

Cited by 12 publications

(9 citation statements)

References 13 publications

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“…Therefore, the reference interval is an approximation of what can be expected in the population. This difficulty has been recognised in critical care medicine leading to calls for the development of a new normative data base for the critically ill 4…”

Section: But What Is Meant By ‘Normal’?mentioning

confidence: 99%

The normal range: it is not normal and it is not a range

Whyte

Kelly

2018

Postgraduate Medical Journal

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The NHS ‘Choose Wisely’ campaign places greater emphasis on the clinician-patient dialogue. Patients are often in receipt of their laboratory data and want to know whether they are normal. But what is meant by normal? Comparator data, to a measured value, are colloquially known as the ‘normal range’. It is often assumed that a result outside this limit signals disease and a result within health. However, this range is correctly termed the ‘reference interval’. The clinical risk from a measured value is continuous, not binary. The reference interval provides a point of reference against which to interpret an individual’s results—rather than defining normality itself. This article discusses the theory of normality—and describes that it is relative and situational. The concept of normality being not an absolute state influenced the development of the reference interval. We conclude with suggestions to optimise the use and interpretation of the reference interval, thereby facilitating greater patient understanding.

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Section: But What Is Meant By ‘Normal’?mentioning

confidence: 99%

The normal range: it is not normal and it is not a range

Whyte

Kelly

2018

Postgraduate Medical Journal

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“…Another type of alert geared to detection are abnormal laboratory value alerts with thresholds that exceed the recommended laboratory limit or higher. Alert thresholds with abnormal values higher than acceptable are often targeted at high specificity and low sensitivity, thus possibly reducing alert fatigue but limiting the value in ADE prevention[40]. Still antidote alerts and alerts set with a high abnormal laboratory value thresholds can be useful in understanding the environment, providing an opportunity to assess for causal factors and preventing future events through systematic changes[37].…”

Section: Detection Of Me and Ades Using Cdsmentioning

confidence: 99%

Clinical decision support for drug related events: Moving towards better prevention

Kane‐Gill

Achanta

Kellum

et al. 2016

WJCCM

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Clinical decision support (CDS) systems with automated alerts integrated into electronic medical records demonstrate efficacy for detecting medication errors (ME) and adverse drug events (ADEs). Critically ill patients are at increased risk for ME, ADEs and serious negative outcomes related to these events. Capitalizing on CDS to detect ME and prevent adverse drug related events has the potential to improve patient outcomes. The key to an effective medication safety surveillance system incorporating CDS is advancing the signals for alerts by using trajectory analyses to predict clinical events, instead of waiting for these events to occur. Additionally, incorporating cutting-edge biomarkers into alert knowledge in an effort to identify the need to adjust medication therapy portending harm will advance the current state of CDS. CDS can be taken a step further to identify drug related physiological events, which are less commonly included in surveillance systems. Predictive models for adverse events that combine patient factors with laboratory values and biomarkers are being established and these models can be the foundation for individualized CDS alerts to prevent impending ADEs.

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“…Brought to you by | Ghent University Library Authenticated Download Date | 12/14/18 11:38 PM standard RIs may not be a reliable tool in assessing critically ill patients because many patients still have derangements upon the discharge from the ICU. In fact, it has previously been shown that adjusted RIs for the ICU population decrease false-positive results and increase true-negative results [13]. Many laboratory derangements do not endanger the ICU patient, do not necessitate further intervention and should not preclude discharge from the ICU.…”

Section: Discussionmentioning

confidence: 99%