21.4 “To Order or Not to Order”: How Useful Is Routine Admitting Blood Work in a Pediatric Psychiatric Inpatient Unit?

Abstract

There is little evidence to suggest that routine admitting blood work enhances a psychiatrist’s treatment and discharge plan, as clinical judgement and thorough histories form the cornerstone of child and adolescent psychiatry. Currently, no North American guidelines exist to inform psychiatrists about appropriate blood work to order for inpatient admissions. Over-ordering can result in unnecessary trauma, expenses, and poor resource allocation. Thus, the primary objective of this study is to determine the clinical relevance of routine blood work completed upon patient admission to a pediatric psychiatric unit. A retrospective chart review of 485 patient admissions to a pediatric psychiatric inpatient unit at a tertiary care teaching hospital in Eastern Ontario between January 1, 2016 and December 31, 2016 was completed. A random selection of 5% of the patient charts was used to determine interrater reliability (r = 0.89). Demographic and clinical information was recorded along with results from 17 routinely ordered laboratory tests. Frequencies were calculated using XLSTAT 2014. Laboratory tests were deemed clinically significant if they: 1) yielded abnormal values; and 2) altered patient management. Routine bloodwork was completed for 79.8% (n = 387; N = 485) of patient admissions: 66.4% (n = 257; N = 387) were female, and 33.5% (n = 130; N = 387) were male. However, only 1.7% of the completed bloodwork was clinically significant. Tests that were the most frequently clinically significant included ferritin (6.1%; 3.9% female, 2.2% male), thyroid stimulating hormone ([TSH] 4.7%; 3.3% female, 1.4% male), and B12 (3.2%; 2.3% female, 0.9% male). The results of this study suggest that laboratory testing rarely adds value to inpatient child and adolescent psychiatry evaluations, given that few led to changes in patient management. Our study proposes that physicians admitting children/youth to the inpatient psychiatry unit order a subset of routine blood work including ferritin, TSH, and B12, and others only as necessary within the context of the patient presentation.