Diagnostic yield of laboratory testing in hospitalized older adults with altered mental status

IF 3.7 2区 医学 Q1 PSYCHIATRY
Kamber L. Hart , Kathleen M. McFadden , Sara B. Golas , Chana A. Sacks , Thomas H. McCoy
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引用次数: 0

Abstract

Background

Altered mental status (AMS) is a common cause of hospitalization among older adults, with a wide range of potential etiologies. However, the diagnostic and therapeutic yield of routine laboratory testing in such patients is unknown.

Methods

In a retrospective cohort of inpatient hospital admissions to a large academic medical center from 2017 to 2022 of patients 65 years and older for whom the admitting diagnosis was AMS, we assessed laboratory testing for thyroid stimulating hormone (TSH), syphilis, vitamin B12, folate, vitamin C, vitamin D, zinc, niacin, and thiamine. We calculated the frequency of testing, rate of abnormal results, and rate of follow-up treatment.

Results

Of the 3169 patients, 2312 (73 %) received at least one designated lab, and overall, 12 % of labs were abnormal. Labs varied in frequency of use (0.2 % for niacin–66 % for TSH) and rate of abnormality (0 % for niacin–71 % for zinc). 16 % of abnormal index labs led to a new prescription at discharge. The most common tests – TSH, folate, and B12– were of relatively low diagnostic and therapeutic utility. Tests that were less common–zinc, vitamin D, and vitamin C–were more commonly abnormal. 3.8 % of patients tested for syphilis had abnormal results, and 72 % of patients with an abnormal result received treatment with penicillin during the index hospitalization.

Conclusions

These analyses suggest that commonly obtained labs in the workup of AMS have varied diagnostic and therapeutic utility. The contribution of observed laboratory abnormalities to a patients' AMS warrants further study to improve the delivery of high-value care.
精神状态改变的住院老年人实验室检查的诊断率
背景:精神状态失调(AMS)是老年人住院治疗的常见原因,具有广泛的潜在病因。然而,常规实验室检查对此类患者的诊断和治疗效果尚不清楚。方法对某大型学术医疗中心2017 - 2022年入院诊断为AMS的65岁及以上住院患者进行回顾性队列研究,评估其促甲状腺激素(TSH)、梅毒、维生素B12、叶酸、维生素C、维生素D、锌、烟酸和硫胺素的实验室检测。我们计算了检测频率、异常结果率和随访率。结果3169例患者中,2312例(73%)接受了至少一个指定化验室检查,12%的化验室检查异常。实验室在使用频率(烟酸为0.2% - TSH为66%)和异常率(烟酸为0% -锌为71%)方面存在差异。16%的实验室指数异常导致出院时重新开处方。最常见的TSH、叶酸和B12检测在诊断和治疗方面的效用相对较低。不太常见的测试——锌、维生素D和维生素c——更常见的是异常。3.8%的梅毒检测结果异常,72%的异常患者在指数住院期间接受了青霉素治疗。结论在AMS的检查中,常用的实验室具有不同的诊断和治疗作用。观察到的实验室异常对患者AMS的贡献值得进一步研究,以改善高价值护理的提供。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
General hospital psychiatry
General hospital psychiatry 医学-精神病学
CiteScore
9.60
自引率
2.90%
发文量
125
审稿时长
20 days
期刊介绍: General Hospital Psychiatry explores the many linkages among psychiatry, medicine, and primary care. In emphasizing a biopsychosocial approach to illness and health, the journal provides a forum for professionals with clinical, academic, and research interests in psychiatry''s role in the mainstream of medicine.
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