Using clinical guidelines to assess the potential value of laboratory medicine in clinical decision-making.

Allan J Hicks,Mike J Hallworth,Eric S Kilpatrick,Zoe L Carwardine

doi:10.11613/bm.2021.010703

Abstract

IntroductionIt is often quoted that 70% of clinical decisions are based on laboratory results, but the evidence to substantiate this claim is lacking. Since clinical guidelines aim to document best-practice decision making for specific disease conditions, inclusion of any laboratory test means that the best available evidence is recommending clinicians use it. Cardiovascular disease (CVD) is the world’s most common cause of mortality, so this study reviewed all CVD guidelines published by five national/international authorities to determine what proportion of them recommended laboratory testing.Materials and methodsFive leading CVD guidelines were examined, namely the European Society of Cardiology (ESC), the UK National Institute for Health and Clinical Excellence (NICE), the American College of Cardiology (ACC), the Australian Heart Foundation (AHF) and the Cardiac Society of Australia and New Zealand (CSANZ).ResultsA total of 101 guidelines were reviewed. Of the 33 individual ESC guidelines relating to CVD, 24/33 made a direct reference to the use of clinical laboratory tests in either diagnosis or follow-up treatment. The same applied to 15/20 of NICE guidelines, 24/32 from the ACC and 15/16 from the AHF/CSANZ. Renal function and blood count testing were the most recommended (39 and 26 times), with lipid, troponin and natriuretic peptide measurement advocated 25, 19 and 19 times respectively.ConclusionsThis study has shown that laboratory testing is advocated by between 73% and 94% of individual CVD guideline recommendations from five national/international authorities. This provides an index to assess the potential value of laboratory medicine to healthcare.

Highlights

It is often quoted that 70% of clinical decisions are based on laboratory results, but the evidence to substantiate this claim is lacking
Of the 33 individual European Society of Cardiology (ESC) guidelines relating to Cardiovascular disease (CVD), 24/33 made a direct reference to the use of clinical laboratory tests in either diagnosis or follow-up treatment
This study has shown that laboratory testing is advocated by between 73% and 94% of individual CVD guideline recommendations from five national/international authorities

Summary

Introduction

It is often quoted that 70% of clinical decisions are based on laboratory results, but the evidence to substantiate this claim is lacking. Since clinical guidelines aim to document best-practice decision making for specific disease conditions, inclusion of any laboratory test means that the best available evidence is recommending clinicians use it. Guidelines and the value of laboratory medicine vation is that the presence of laboratory results in a patient record does not necessarily equate to it being used in any clinical decision-making process [3]. A 2016 study of laboratory use by oncologists and cardiologists found that 75% of all their patients underwent laboratory testing, and that this testing led to a substantial clinical decision in 66% of the patients [4]

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Results

Conclusion