“Lipase Only, Please”: Reducing Unnecessary Amylase Testing

Holzer, Horatio; Reisman, Adam; Marqueen, Kathryn E.; Thomas, Andrea; Yang, Anthony D.; Dunn, Andrew; Jia, Rachel; Poeran, Jashvant; Cho, Hyung J.

doi:10.1016/j.jcjq.2019.08.003

Cited by 9 publications

(9 citation statements)

References 14 publications

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“…1,22 This will lead to financial savings, minimal loss of clinically useful information, and a reduction in health care waste and resources. 23,24…”

Section: Discussionmentioning

confidence: 99%

Utility of Serum Amylase in Children With Abdominal Pain in the Pediatric Emergency Department

2023

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Objectives Abdominal pain is among the most common chief complaints seen in pediatric emergency departments (PEDs). This study aims to evaluate the diagnostic utility of amylase and lipase in the evaluation of abdominal pain in the PED. Methods Retrospective, cross-sectional study of patients aged 0 to 18 years with amylase and/or lipase while in the PED in 2019. Diagnostic utility of amylase and lipase was analyzed with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratio (LR). The χ2 or Fisher exact test was used when appropriate. Results We identified 496 PED visits with tests for amylase (0.2%), lipase (53%), or both (46.8%). Abnormal levels for amylase and lipase were 4.6% and 5.6%, respectively. Amylase use in abdominal pain evaluation showed sensitivity of 30%, specificity of 92%, PPV of 26%, NPV of 93%, and LR of 7.1 (P = 0.008). Lipase use in abdominal pain evaluation showed sensitivity of 7.5%, specificity of 94.5%, PPV of 10.7%, NPV of 92%, and LR of 0.251 (P = 0.616). Amylase at 3 times its normal level showed sensitivity of 10%, specificity of 99.5%, PPV of 66.7%, NPV of 92.2%, and LR of 6.35 (P = 0.012), whereas lipase showed a sensitivity of 5%, specificity of 99.3%, PPV of 40%, NPV of 92.2%, and LR of 3.9 (P = 0.048). Identification of a clinically significant diagnosis via coordering of amylase and lipase versus lipase alone was not significant. Conclusions Although serum amylase and lipase testing may be suitable for abdominal pain screening, the concurrent use of both does not seem to add any clinically significant value to diagnosis.

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“…1,22 This will lead to financial savings, minimal loss of clinically useful information, and a reduction in health care waste and resources. 23,24…”

Section: Discussionmentioning

confidence: 99%

Utility of Serum Amylase in Children With Abdominal Pain in the Pediatric Emergency Department

2023

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“…3,4 Considerable laboratory cost savings are associated with a lipase-only policy, and several institutions have demonstrated successful lipase-only test reduction strategies. 3,5 David Alter, MD David D. Koch, PhD…”

Section: A Review Of Acute Pancreatitismentioning

confidence: 99%

“…The California law targets the 8% to 13% of drugs offering coupons that have direct generic competitors. 4,5 Broader coupon bans offer greater potential to promote use of costsaving generics, but they could raise patient out-of-pocket costs and lower adherence. 2,6 States may consider pairing broader coupon bans with reforms to protect patients from facing excessive cost sharing for essential medicines.…”

Section: Association Of California's Prescription Drug Coupon Ban Wit...mentioning

confidence: 99%

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Association of California’s Prescription Drug Coupon Ban With Generic Drug Use

Rome

Gagne

Kesselheim

2021

JAMA

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“…Consequently, many studies, in conjunction with the American Board of Internal Medicine’s Choosing Wisely initiative, recommend that lipase should replace amylase for the evaluation of suspected acute pancreatitis . Considerable laboratory cost savings are associated with a lipase-only policy, and several institutions have demonstrated successful lipase-only test reduction strategies …”

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confidence: 99%