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Clin Chem Lab Med. 2019 Nov 16. pii: /j/cclm.ahead-of-print/cclm-2019-1004/cclm-2019-1004.xml. doi: 10.1515/cclm-2019-1004. [Epub ahead of print]

Impact of delta check time intervals on error detection capability.

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Engineering Cluster, Singapore Institute of Technology, Singapore, Singapore.
Division of Chemical Pathology, SA Pathology, Women's and Children's Hospital, Adelaide, South Australia, Australia.
Department of Laboratory Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore, Phone: +65-67724345; Fax: +65-67771613.


Background The delta check time interval limit is the maximum time window within which two sequential results of a patient will be evaluated by the delta check rule. The impact of time interval on delta check performance is not well studied. Methods De-identified historical laboratory data were extracted from the laboratory information system and divided into children (≤18 years) and adults (>21 years). The relative and absolute differences of the original pair of results from each patient were compared against the delta check limits associated with 90% specificity. The data were then randomly reshuffled to simulate a switched (misidentified) sample scenario. The data were divided into 1-day, 3-day, 7-day, 14-day, 1-month, 3-month, 6-month and 1-year time interval bins. The true positive- and false-positive rates at different intervals were examined. Results Overall, 24 biochemical and 20 haematological tests were analysed. For nearly all the analytes, there was no statistical evidence of any difference in the true- or false-positive rates of the delta check rules at different time intervals when compared to the overall data. The only exceptions to this were mean corpuscular volume (using both relative- and absolute-difference delta check) and mean corpuscular haemoglobin (only absolute-difference delta check) in the children population, where the false-positive rates became significantly lower at 1-year interval. Conclusions This study showed that there is no optimal delta check time interval. This fills an important evidence gap for future guidance development.


delta check; laboratory error; misidentified samples; time interval; wrong blood in tube


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