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Routine Laboratory Testing for Medical Disorders in Psychiatric Inpatients

Routine Laboratory Testing for Medical Disorders in Psychiatric Inpatients Abstract • We examined the clinical utility of routine admission laboratory testing for medical disorders in 250 psychiatric inpatients by using clinical criteria to classify laboratory abnormalities as true- or false-positive results. The mean number of tests per patient was 27.7. The mean percentage of true-positive results was 1.8%; the mean predictive value was 12%. When three clinically defined subgroups were examined, both measures of test performance varied in direct proportion to the pretest probability of medical disease. Eleven patients (4%) had important medical problems discovered through routine laboratory testing. A testing battery consisting of nine tests in women and 13 in men would have identified all of these patients. Our results suggest that extensive, routine testing for medical disorders in this setting is unnecessary and that more efficient and accurate testing strategies, based on clinical information, can and should be developed. (Arch Intern Med 1985;145:2085-2088) References 1. Korvin CC, Pearce RH, Stanley J: Admissions screening: Clinical benefits. Ann Intern Med 1975;83:197-203.Crossref 2. Durbridge TC, Edwards F, Edwards RG, et al: An evaluation of multiphasic screening on admission to hospital. Med J Aust 1976;1:703-705. 3. Hall CH, Nie NH (eds): SPSS Update: New Procedures and Facilities for Releases 7 and 8. New York, McGraw-Hill Book Co, 1979, pp 104-105. 4. American Psychiatric Association Committee on Nomenclature and Statistics: Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1980. 5. Griner PF, Mayewski RJ, Mushlin AI, et al: Selection and interpretation of diagnostic tests and procedures: Principles and applications. Ann Intern Med 1981;94:557-600. 6. Daniel WW: Biostatistics: A Foundation for Analysis in the Health Sciences , ed 2. New York, John Wiley & Sons Inc, 1978, pp 189-190. 7. Hall RC, Gardner ER, Stillney SK, et al: Physical illness manifesting as psychiatric disease. Arch Gen Psychiatry 1980;37:989-995.Crossref 8. Koranyi EK: Undiagnosed physical illness in psychiatric patients. Ann Rev Med 1982;33:309-316.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Routine Laboratory Testing for Medical Disorders in Psychiatric Inpatients

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Publisher
American Medical Association
Copyright
Copyright © 1985 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1985.00360110161032
Publisher site
See Article on Publisher Site

Abstract

Abstract • We examined the clinical utility of routine admission laboratory testing for medical disorders in 250 psychiatric inpatients by using clinical criteria to classify laboratory abnormalities as true- or false-positive results. The mean number of tests per patient was 27.7. The mean percentage of true-positive results was 1.8%; the mean predictive value was 12%. When three clinically defined subgroups were examined, both measures of test performance varied in direct proportion to the pretest probability of medical disease. Eleven patients (4%) had important medical problems discovered through routine laboratory testing. A testing battery consisting of nine tests in women and 13 in men would have identified all of these patients. Our results suggest that extensive, routine testing for medical disorders in this setting is unnecessary and that more efficient and accurate testing strategies, based on clinical information, can and should be developed. (Arch Intern Med 1985;145:2085-2088) References 1. Korvin CC, Pearce RH, Stanley J: Admissions screening: Clinical benefits. Ann Intern Med 1975;83:197-203.Crossref 2. Durbridge TC, Edwards F, Edwards RG, et al: An evaluation of multiphasic screening on admission to hospital. Med J Aust 1976;1:703-705. 3. Hall CH, Nie NH (eds): SPSS Update: New Procedures and Facilities for Releases 7 and 8. New York, McGraw-Hill Book Co, 1979, pp 104-105. 4. American Psychiatric Association Committee on Nomenclature and Statistics: Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1980. 5. Griner PF, Mayewski RJ, Mushlin AI, et al: Selection and interpretation of diagnostic tests and procedures: Principles and applications. Ann Intern Med 1981;94:557-600. 6. Daniel WW: Biostatistics: A Foundation for Analysis in the Health Sciences , ed 2. New York, John Wiley & Sons Inc, 1978, pp 189-190. 7. Hall RC, Gardner ER, Stillney SK, et al: Physical illness manifesting as psychiatric disease. Arch Gen Psychiatry 1980;37:989-995.Crossref 8. Koranyi EK: Undiagnosed physical illness in psychiatric patients. Ann Rev Med 1982;33:309-316.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Nov 1, 1985

References