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Ann Emerg Med. 1991 Jan;20(1):16-21.

Rational ordering of electrolytes in the emergency department.

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  • 1Department of Emergency Medicine, Valley Medical Center, Fresno, California.

Abstract

STUDY OBJECTIVE:

To validate the predictive abilities of a retrospectively developed set of clinical criteria for detecting clinically significant electrolyte abnormalities, using a different patient population.

DESIGN:

Cross-sectional study.

SETTING:

The emergency department of a busy public hospital.

TYPE OF PARTICIPANTS:

Nine hundred eighty-two patients on whom the emergency physician ordered serum electrolytes.

INTERVENTIONS:

The predictive properties of ten clinical criteria were evaluated; these included poor oral intake, vomiting, chronic hypertension, taking a diuretic, recent seizure, muscle weakness, age of 65 years or more, alcoholism, abnormal mental status, and recent history of electrolyte abnormality.

MEASUREMENTS AND MAIN RESULTS:

Seven hundred thirty patients (74.3%) had one or more electrolytes outside of the laboratory normal range, but only 143 (14.6%) had clinically significant electrolyte abnormalities. The clinical criteria predicted 135 of the clinically significant electrolyte abnormalities (sensitivity, 94.4%). When the eight "false-negative" cases were reviewed, none of the electrolyte abnormalities affected patient outcome. Implementation of the criteria would have avoided unnecessary testing in 233 patients (23.7%).

CONCLUSION:

Although no set of clinical criteria can eliminate the need for clinical judgment, use of a set of clinical criteria could substantially decrease electrolyte ordering without compromising patient care.

PMID:
1984721
[PubMed - indexed for MEDLINE]
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