The Value of Screening Inpatients with Creatine Kinase Testing

Abstract

Today’s healthcare environment mandates cost-effective utilization of ancillary services, and routine laboratory test panels are often suggested as a target for cost reduction. Over the last 30 years, large multitest profiles have become routine in medical practice and are used to “screen” patients for disease (1)(2), presumably identifying conditions not part of a patient’s clinical presentation (3)). However, many studies over the last 20 years have suggested that the use of test profiles provides little benefit toward identification of unknown diseases (4)(5)(6)(7)(8)(9)). Indeed, it has been suggested that the widespread use of panels was a function of the available continuous flow analyzers (10)(11)) and the increased profits afforded laboratories before the establishment of diagnosis-related groups. Reagent cost savings from elimination of test panels would be trivial in the overall cost of healthcare operations. However, substantial savings might be realized by decreasing the follow-up of slightly “abnormal” results, which yields few new diagnoses (12)(13)(14)). In the US, the number of “panels” and the number of tests per panel are being minimized to some extent as a result of the new Healthcare Financing Administration-mandated panels and the documentation of medical necessity now required for some forms of reimbursement (15)). We had included a test for total creatine kinase (CK) in a 12-test routine admission panel before May 1, 1996, after which we eliminated several tests from this panel, including CK. One reason for removing CK from this panel was an earlier study that had shown that admission CK tests did not lead to new diagnoses (16)). Here we asked whether the prior presence of CK in the panel facilitated the diagnosis of myocardial infarction (MI) for inpatients. All inpatient admissions to Barnes-Jewish Hospital …