The erythrocyte sedimentation rate in general practice: Clinical assessment based on case histories

Abstract

Thirteen case histories were mailed to 273 general practitioners to study the clinical assessment of the ESR. Participants were asked to state their reference limits for the ESR, as well as action values for the ESR in several clinical situations typical of primary care. The action value should represent the minimal ESR change from a given value necessary to initiate some kind of action towards the patient. The response rate was 76%. In most case histories, half the general practitioners reacted on an ESR change of 10 mm h-1 or less, which is usually due to analytical and biological variation, thus underlining the need for good analytical quality. In general the response was of the same magnitude irrespective of type of case history, i.e. whether the ESR was used in case finding, in diagnosis, or in follow-up. Estimation of the reference limit displayed considerable variation, and knowledge of a previous 'normal' ESR was of minor clinical importance. Furthermore, we found substantial variation regarding the change in ESR necessary to take action in different clinical situations. In principle, for many general practitioners the action value increased as the given ESR increased whereas others reacted on a constant change in ESR, or the change necessary to take action depended on the clinical situation. We conclude that both the different assessments as to the clinical significance of the ESR, and the unawareness of the significance of analytical and biological variation indicate that guidelines for rational use are needed.

Analytical performance specifications based on how clinicians use laboratory tests. Experiences from a post-analytical external quality assessment programme

“…Evaluation of the erythrocyte sedimentation rate (ESR) test was done by presenting 12 case histories to Norwegian GPs [6]. In principle, for many GPs the action value increased as the given ESR increased, whereas others reacted on a constant change in ESR, or the change necessary to take action was highly dependent on the clinical situation.…”

“…During 1991-2012 Noklus published a series of papers on post-analytical quality assessment addressing how physicians used and interpreted laboratory tests both in Norway and internationally, with mainly European data [4][5][6][7][8][9][10][11][12][13]. All but one study used case histories with feedback reports as the research/educational instrument.…”

Diagnosis of Periprosthetic Joint Infection: The Threshold for Serological Markers

“…However, regardless of the diagnostic criteria, measurement of ESR and CRP has been deemed an important part of the workup of patients suspected of PJI [42]. These valuable markers can be performed rapidly, inexpensively, [12,25,32,36,37,41]. Therefore, it seems to be impossible to convert these quantitative tests into absolute binary systems (ie, infected versus noninfected).…”

Inflammatory activity: Capillary electrophoresis provides more information than erythrocyte sedimentation rate

“…The many factors influencing ESR makes it difficult to interpret an ESR result. This is probably the cause of the great inter-individual variability in interpretation of ESR results previously reported [24]. In contrast to ESR, capillary electrophoresis can be analysed retrospectively on stored plasma samples and the assay can be centralised, which is important in clinical studies to eliminate interlaboratory variation.…”