Screening Investigations in the Elderly

Abstract

The study evaluates the usefulness of some commonly used screening investigations in the management of elderly acutely ill medical patients. It was performed on 50 consecutive admissions to one ward and all patients received a full blood count, ESR, urea and electrolyte estimation, liver function tests, thyroid function tests, examination of a mid-stream urine specimen and P-A chest X-ray examination. When performed in the absence of clinical indication these tests were considered to be screening tests. On assessing the tests performed prospectively, it was shown that only a full blood count, urea and electrolyte estimation, ward testing of urine, and, possibly, a P-A chest X-ray examination are worthwhile screening investigations in this patient population. The ESR and liver function tests and mid-stream urine specimens seem to be of little value in the absence of clinical indication.

Practice Advisory for Preanesthesia Evaluation

“…Hemoglobin/Hematocrit Measurement. In asymptomatic or nonselected patients, abnormal hemoglobin findings were reported in 0.5% to 65.4% of patients 8,70,107,114,[132][133][134][135][136][137][138][139][140] and led to cancellations or changes in management in 2.4 -28.6% of cases with abnormal findings (Category B2 evidence). 70,133,138,139 For selected or indicated patients, abnormal hemoglobin findings were reported in 54.0% of patients (Category B2 evidence).…”

“…70,133,138,139 For selected or indicated patients, abnormal hemoglobin findings were reported in 54.0% of patients (Category B2 evidence). 114 Changes in clinical management were not reported.…”

Value of profiling liver function in the elderly

“…The finding of normal function may also contribute to patient management. Sewell et al, (1981) found there was no value in measuring liver function tests in the elderly. However, in the present series, profiling liver function, without clinical indication, produced abnormal results in 16-6% of all patients examined.…”

Recomendaciones de pruebas preoperatorias en el paciente adulto para procedimientos en régimen de cirugía ambulatoria

“…En pacientes no seleccionados y asintomáticos las alteraciones en los niveles de sodio se han reflejado hasta en un 1,9%, y en los de potasio varían alrededor del 0,2 al 16% 56,58,61,71 . La Agencia de Evaluación de Tecnología Sanitaria del Reino Unido evaluó, en su reciente documento, estudios realizados en pacientes ASA I y II, y constató que las anomalías de los electrólitos y creatinina no llevaron a cambios en el manejo clínico, ni se asociaron con complicaciones cardiacas ni muerte 10 .…”

“…Se han detectado niveles de potasio fuera de rango cuando se determinan en pacientes con sintomatología o indicación clínica, en alrededor del 2,9 al 71%; sin embargo, los estudios no reflejan cambios en el manejo clínico 8,58 .…”